MTM Updates Are Coming in 2025

When the new year arrives, exciting updates for medication therapy management (MTM) will make more patients eligible for MTM services. One of the top updates is adding HIV/AIDS to the core chronic diseases that Medicare Part D sponsors must include for MTM services.¹ This new requirement begins January 1, 2025. Pharmacists are vital to implementing MTM updates in 2025 as an integral part of the health care team.

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MTM Updates

The Centers for Medicare & Medicaid Services (CMS) issued a final rule in April 2024 to update specific MTM program requirements. One of the most notable additions is HIV/AIDS as part of the targeting criteria.¹ Now, the following 10 core chronic diseases must be included¹:

• Alzheimer disease
• Diabetes
• Congestive heart failure
• Bone disease/arthritis (osteoporosis, osteoarthritis, and rheumatoid arthritis)
• End-stage renal disease
• Dyslipidemia
• HIV/AIDS
• Hypertension
• Respiratory disease (ie, asthma, chronic obstructive pulmonary disease, chronic lung disorders)
• Mental health (ie, depression, schizophrenia, bipolar disorder, and chronic/disabling mental health conditions)

Pharmacists play a critical role in MTM services for patients with HIV/AIDS. The American Society of Health-System Pharmacists developed guidelines for pharmacist involvement.² Examples include HIV testing, disease state management, managing complications, and patient education. Including pharmacists in an interdisciplinary health care team can improve patient outcomes.² Studies show that pharmacists can improve public health through community-based point-of-care screening for HIV and other infections, such as hepatitis C.³

Antiretroviral therapy (ART) can interact with concomitant medications, foods, and supplements. As drug experts, pharmacists can screen for any interactions.² Pharmacists can educate the health care team and patients about ART recommendations based on their drug interaction assessment. Pharmacists also play a vital role by providing HIV education to health care professionals and patients. This includes educating physicians about ART selection and dosing, providing continuing education programs, and conducting in-service training.² Educating pharmacy students through their didactic training and clinical rotations is also critical. Patient education should include medication adherence and community outreach programs.

Additional changes for 2025 include updating the cost threshold to $1623.¹ This is the average cost that Medicare Part D beneficiaries are likely to pay for 8 generic drugs.1 In turn, this makes more patients eligible for MTM services. Additionally, sponsors must include all Part D medications in their MTM program targeting criteria. These medications should be available through a searchable drug database. The language specifying only including certain Part D medications has been removed.¹

CMS also updated guidance to ensure comprehensive medication reviews (CMRs) are conducted through real-time telehealth consultations by a pharmacist or other qualified health care professional.¹ This can include in-person or other interactive technology methods such as videoconferencing and telephone. Individual Medicare plans can determine how CMRs are conducted.¹ The CMR should include a discussion of patients’ prescription medications, OTC drugs, and dietary supplements.¹ Pharmacists should address patient concerns about pharmacotherapy and ensure they take their medications appropriately.

REFERENCES

1. Duran VS. Contract year 2025 Part D medication therapy management program guidance and submission instructions. Centers for Medicare & Medicaid Services. May 6, 2024. Accessed October 27, 2024. https://www.cms.gov/files/document/memo-contract-year-2025-medication-therapy-management-mtm-program-submission-v050624.pdf

2. Schafer JJ, Gill TK, Sherman EM, McNicholl IR. ASHP guidelines on pharmacist involvement in HIV care. Am J Health Syst Pharm. 2016;73(7):468-494. doi:10.2146/ajhp150623

3. Klepser DG, Klepser ME, Peters PJ, Hoover KW, Weidle PJ. Implementation and evaluation of a collaborative, pharmacy-based hepatitis C and HIV screening program. Prev Chronic Dis. 2022;19:E83. doi:10.5888/pcd19.220129