NOVEMBER 01, 2006

The nation's pharmacists are being frozen out of medication therapy management (MTM) by Part D drug plans that are failing to provide meaningful MTM services to seniors, health care advocates charged. Those allegations are a bitter pill for organized pharmacy, which fought for and won provisions in the new Medicare drug law requiring Part D drug plans to make MTM benefits available to their members.

Despite that congressional mandate, however, a brief prepared by the Medicare Rights Center maintains that the majority of Part D drug plans are not offering patients face-to-face medication counseling and other MTM services by trained pharmacists. According to the advocacy group, the Centers for Medicare & Medicaid Services (CMS) has given private insurers too much discretion in the design of the MTM services under Part D.

As a result, "the majority of popular plans are only providing educational material by mail or over the phone with in-house staff rather than face-toface interaction with an independent pharmacist or care team," officials at the Medicare Rights Center charged. "Few plans provide comprehensive medical review or follow-up."

Under the law, MTM services must be designed "to optimize therapeutic outcomes through improved medication use and to reduce the risk of adverse events" for private Medicare drug plan members who have multiple chronic diseases, are taking multiple medications, or are likely to incur high annual drug costs.

"If the Centers for Medicare & Medicaid Services considers medication therapy management to be the ‘cornerstone'of the Medicare drug benefit, as it says, then it should regulate private plans and not bow to them," said Medicare Rights Center President Robert M. Hayes. "Until CMS raises the bar and requires profiteering drug plans to utilize the best medication therapy management practices available today, people will suffer needlessly and have costly hospital and nursing homes stays."