Changes to MTM Requirement Needed

Pharmacy Times
Volume 0

Ms. Khani and Mr. Sewell arecopresidents of the Coalition forCommunity Pharmacy Action.

As policymakers begin to debatethe key issues within healthcare reform, the Coalition forCommunity Pharmacy Action (CCPA)is urging Congress to strengthen theexisting medication therapy management(MTM) requirement in MedicarePart D. The coalition is advocating forchanges to the MTM benefit in orderto improve patient health as well asreduce overall Medicare expenditures.

Julie Khani

Vice president

of federal


programs at


Charles Sewell

Senior vice


of government

affairs at


The Medicare Modernization Act of2003 (MMA) was signed to providea comprehensive federal prescriptiondrug benefit to >40 million seniorsand individuals with disabilities whoqualified under Medicare to help themafford the cost of their medicines. Italso was intended to provide seniorsand individuals more choices in healthcare, better benefits, and savings.

For instance, seniors could choosea stand-alone drug plan or have theirdrug benefit incorporated into broadermedical coverage. These provisionswere to modernize Medicare and giveindividuals more control over the costsof their health care and give themaccess to coverage that is affordable,flexible, and portable.

Since MMA was established in 2006,beneficiaries have had wider access toprescription drugs, and recent reportsreveal that satisfaction with Part Damong seniors has been high. An importantaspect of the legislation is therecognition of the value of MTM forbeneficiaries who receive benefitsunder the program.

The MMA requires Medicare healthplans to make MTM programs availableto targeted beneficiaries. Patientsmust have multiple disease states, takemultiple Part D?covered medications,and be likely to reach a designatedamount in prescription drug spending.In 2008, the set spending amount was$4000.

Under the MMA, these programs areto be developed in cooperation withpharmacists and physicians, and caremay be provided by pharmacists. Therequirements, however, are vague andlack uniform standards. As a result,services to Medicare beneficiaries varywidely.

For example, one Part D plan mightprovide MTM services for a beneficiarywith 3 chronic conditions and 5prescriptions, whereas another PartD plan might provide MTM servicesfor a beneficiary with 2 chronic conditionsand 3 prescriptions. This lack ofstandardization is unfair to Medicarebeneficiaries and limits the potentialof MTM programs to improve care andmaximize savings to the Medicare program.If the current requirements arenot standardized to ensure appropriateutilization, beneficiaries will not reapthe full benefits of the Medicare PartD program.

CCPA is advocating for several changesto the existing MTM requirementin Medicare Part D. MTM programsshould be available to any MedicarePart D beneficiary with a condition thatis likely to increase federal health carespending, regardless of whether thepatient meets the annual cost threshold.Furthermore, CCPA believes thatthere should be strong pharmacyaccess requirements to ensure wideavailability of MTM programs throughcommunity pharmacies.

TheCoalition for CommunityPharmacy Action (CCPA) is analliance between the NationalAssociation of Chain Drug Stores(NACDS) and the National CommunityPharmacists Association (NCPA),which together represent more than55,000 community pharmacies. CCPAleverages the support, effort, andinfrastructure of NACDS and NCPAwhile engaging community pharmacyto participate and advocate on issuesaffecting the industry.

An important first step in the expansionof MTM would be coverage ofan annual medication review for targetedMedicare Part D beneficiaries.This review would increase the likelihoodof Medicare beneficiaries takingtheir prescription drugs appropriately,improving patient health and reducinghigher-cost medical services.

The majority of Medicare Part Dprescriptions are filled by the membersof the National Association ofChain Drug Stores and the NationalCommunity Pharmacists Association.Working together through CCPA, westrive to improve the Medicare Part Dprogram. Expanding MTM programsin Medicare will improve the healthand well-being of Medicare beneficiaries,improve health outcomes, andreduce health care costs. The coalitionis committed to advocating for theseimportant changes, advancing the roleof pharmacy as part of the health caresystem.

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