Part D Enhanced Medication Therapy Management Model

WASHINGTON, D.C. (September 28, 2015)—Monday, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) announced a model to test strategies to improve medication use among Medicare beneficiaries enrolled in Part D. Medication therapy management, when implemented effectively, can improve health care and outcomes for patients and has the potential to lower overall health care costs.

The Part D Enhanced Medication Therapy Management (Enhanced MTM) model will assess whether providing selected Medicare Prescription Drug Plans (PDPs) with additional incentives and flexibilities to design and implement innovative programs will better achieve the overall goals for MTM programs, including:

• improving compliance with medication protocols, including 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 their or their 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, M.D., MSc, CMS acting principal deputy administrator and chief medical officer. “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 Enhanced MTM model test will begin January 1, 2017 with a five-year performance period. CMS will test the model in 5 Part D regions:

• Region 7 (Virginia)
• Region 11 (Florida),
• Region 21 (Louisiana),
• Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming), and
• Region 28 (Arizona).

Eligible stand-alone PDPs in these regions 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 waive current MTM program requirements for participating plans in the test regions during the performance period. Participating plans, which are limited to plans offering a basic benefit, are expected to work closely with their network pharmacy providers and local prescribers to accurately identify enrollees whose medication usage has caused, or is likely to cause, adverse outcomes and/or significant non-drug program costs. Beneficiaries who are identified will be contacted by their drug plans, pharmacists, or prescribers and offered targeted assistance in order to optimize medication use and avoid any medication-related problems.

More information about the Enhanced MTM model test can be found in the model announcement, available at http://innovation.cms.gov/initiatives/enhancedmtm/. Please also save the date for a webinar on the Enhanced MTM model test, to be held on October 21, 2015. Registration information will be available on the same site.

CMS will accept applications for the Enhanced MTM via a Request for Applications (RFA), to be released shortly. Once released, application materials will be available at: http://innovation.cms.gov/initiatives/enhancedmtm/.