Pharmacy Stakeholders Call for Strengthened MTM Program

Lawmakers are seeking input on potential improvements for the medication therapy management (MTM) program for Medicare Part D beneficiaries.

Pharmacy stakeholders recently testified before members of the House Energy & Commerce Subcommittee on Health about both the benefits and challenges of MTM as it is currently structured under Medicare Part D.

At the subcommittee hearing, Rite Aid director of field clinical services Jesse McCullough, PharmD, said the primary objectives of his testimony were to address the challenges of the program and make suggestions for how to improve the quality of the MTM program by reducing or eliminating barriers.

The major challenges he outlined were a lack of incentives for plans, providers, and beneficiaries; poor targeting of beneficiaries; lack of beneficiary education and awareness; and prohibitive documentation requirements.

Dr. McCullough noted that Medicare beneficiaries with chronic conditions call on 13 different physicians, on average; have 50 different prescriptions filled every year; account for 76% of all hospital admissions; and are 100 times more likely to have a preventable hospitalization.

“Yet, medication management services are poorly integrated into existing health care systems,” he testified. “Poor medication adherence alone costs the nation approximately $290 billion dollars annually.”

Dr. McCullough said several studies—including ones conducted by the US Centers for Medicare and Medicaid Services (CMS)—have shown positive outcomes for both patients and health care spending when MTM is implemented.

A study published earlier this year found that patients who received a full range of MTM services from a pharmacist within 1 week of discharge experienced significantly lower readmissions than those who received usual care.

Reduced hospital admissions are beneficial for patients as well as facilities. It is an increasingly important quality metric as the health care system continues to move toward a value-based care model.

As part of his suggestions, Dr. McCullough pointed to legislation called the MTM Empowerment Act that is currently being considered in Congress. Among other provisions, this federal bill would allow Medicare beneficiaries to receive Part D benefits for a single chronic condition proven to be responsive to better medication adherence.

Currently, patients must have 3 of the qualifying conditions—which include diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), and high cholesterol—to receive MTM services.

Improved access to MTM services is already on CMS’s radar. The agency announced in September that its Part D Enhanced MTM Model will evaluate the results of new approaches to MTM over the course of 5 years.

Discussions about patient access to health care also led pharmacy stakeholders to take the opportunity to discuss provider status legislation currently pending in Congress.

The Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 592) would allow Medicare beneficiaries in medically underserved areas to receive access to and coverage of certain pharmacists’ patient health care services, including MTM services.

“Where we have a tremendous opportunity is making sure the patient’s therapy is as efficacious as possible,” Dr. McCullough said. “However, as it is right now, we do not have the capacity to be able to bill for services like that.