Updated: Aug 12, 2022
Since the Comprehensive Medication Review (CMR) completion rate became a Star measure, Part D sponsors have devoted internal and vended resources to achieving 4-5 star completion rates for the members who are eligible and enrolled in the Medication Therapy Management (MTM) program. This Star rating focus has adversely impacted what the MTM program was originally intended to accomplish.
Per § 423.153(d), Part D sponsors must establish an MTM program that—
Is designed to ensure that covered Part D drugs prescribed to targeted beneficiaries, as described below, are appropriately used to optimize therapeutic outcomes through improved medication use;
Is designed to reduce the risk of adverse events, including adverse drug interactions, for targeted beneficiaries;
May be furnished by a pharmacist or other qualified provider;
May distinguish between services in ambulatory and institutional settings; and
Must be developed in cooperation with licensed and practicing pharmacists and physicians.
The outcomes of a meaningful MTM program should be as important as the percentage of enrolled members who received an annual CMR. Yet, monitoring and outreach of recommended actions for the member and/or their prescriber are mostly non-existent.
Targeted Medication Reviews (TMRs) are required to be conducted quarterly on those members enrolled in the MTM program. These reviews are intended to address specific or potential medication issues that could have occurred after the annual CMR or as the result of a transition of care. The TMRs can include prescriber communications or recommendations and interventions as appropriate and provide an excellent vehicle for outreach to prescribers for on-going medication issues still represented in the TMRs.
Ultimately, Plan Sponsors are expected to have a process in place to measure, analyze, and report the outcomes of their MTM programs:
Have therapy goals been reached or not?
Were medication therapy recommendations made?
Were there changes as a result of the recommendations?
Were beneficiaries and providers satisfied with the MTM program services and outcomes?
Review and assess your MTM program to see if they include any of the following
examples of medication therapy problem recommendations:
Needs additional therapy
Unnecessary drug therapy
Dosage too high
Dosage too low
Availability of a more effective drug
Adverse drug reaction
Non-compliance or non-adherence to drug therapy
Assess the MTM program for any of the following resolutions:
Start new medication
Change medication (different therapeutic class, dose, dosage form, quantity or dosing schedule
Discontinue or substitute medication (stop using medication, use generic substitute, use formulary substitute)
Compliance or adherence to medication regimens
If your health plan can review and collect MTM program outcomes as outlined, you are on your way to a meaningful and relevant MTM program beyond simple completion rates.
We are ready to support your organization and assist with a strategic assessment of your MTM Program. Contact us TODAY to get started.