CMS to Test New Model for Improving Medication Use

Medication therapy management could improve health care outcomes for patients and lower overall costs.

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) recently announced a new model to test strategies for improving medication utilization among beneficiaries enrolled in Part D.

Medication therapy management has the potential to improve health care and outcomes for patients, in addition to lowering overall health care costs when implemented effectively.

The Part D Enhanced Medication Therapy Management (Enhanced MTM) model will determine whether or not providing selected Medicare Prescription Drug Plans (PDPs) with additional incentives and flexibilities to design and implement innovative programs to improve the overall goals for MTM programs.

These goals include improving compliance with medication protocols, such as high-cost drugs, ensuring that beneficiaries get the medications they need, and they are used properly; reducing medication-related problems, such as duplicative or harmful prescription drugs, or suboptimal treatments; increasing patients’ knowledge of their medications to better achieve prescribers’ goals of therapy; and improving communication among prescribers, pharmacists, caregivers, and patients.

“As part of our approach to building a health care delivery system that results in better care, smarter, spending and healthier people, CMS will test changes to the Part D program to give prescription drug plans stronger incentives and flexibility to improve prescription drug safety and efficacy,” said Patrick Conway, MD, MSc, CMS acting principal deputy administrator and chief medical officers. “Through this model, we are hopeful that Part D plans will invest in medication therapy management and identify new, effective strategies to optimize medication use and improve care coordination in Medicare.”

The model test will begin January 1, 2017 and will have a 5-year performance period. CMS will test the model in 5 regions (11 states), including Virginia, Florida, Louisiana, Iowa, Minnesota, Montana Nebraska, North Dakota, South Dakota, Wyoming, and Arizona.

Eligible stand-alone PDPs in these states can apply to vary the intensity and types of MTM interventions they offer based on beneficiary risk level and seek out a range of strategies to individualize beneficiary outreach and engagement. CMS will disregard current MTM program requirements during the period in which the model will be tested for participating plans in the indicated states.

Participating plans, or those plans limited to offering a basic benefit, are expected to work intimately with network pharmacy providers and local prescribers in order to accurately define enrollees whose medication has caused, or is likely to cause, adverse outcomes and/or significant non-drug program costs. Beneficiaries who fit this category will be contacted by their drug plans, pharmacists, or prescribers, and given targeted assistance in order to improve medication use and avoid medication-related issues.