MTM Services Underused in Part D Drug Plans

Less than half of Medicare enrollees eligible for MTM services receive consultations from a clinical pharmacist.

Although the US Centers for Medicare and Medicaid Services (CMS) requires all Medicare prescription drug (Part D) plans to provide medication therapy management (MTM) services to beneficiaries meeting certain criteria, less than half of eligible enrollees receive those services.

According to an analysis from Avalere Health, CMS estimates 25% of Part D enrollees are eligible for MTM services. Among the top 10 Medicare Part D carriers, however, MTM enrollment rates ranged from 4.6% to 17.5%, for an average of 11% of enrollees receiving the services.

In 2012, Medicare beneficiaries were eligible for MTM services if they had at least 2 chronic conditions, were taking at least 3 medications, and had annual drug spending exceeding $3100. Although Part D plans are also required to offer comprehensive medication review (CMR) to all MTM enrollees, Avalere’s analysis showed considerable variation in implementation of those services. CMR enrollment ranged from 2.4 to 74%, with an average of 9.6% of enrollees receiving the services.

“With only half of enrollees eligible for MTM programs receiving benefits, the Avalere analysis shows that these valuable services are under-used in Medicare,” Avalere Health CEO Dan Mendelson said in a press release. “As regulators consider reforms, they will need to balance access to services with the operation realities faced by health plans.”

Despite the low participation in MTM programs, Medicare Advantage prescription drug plan enrollees were 3 times as likely as those in standalone prescription drug plans to receive CMR. Patients in these plans were 4 times as likely to receive an intervention as a result of CMR, including either outreach to a prescriber or a change in therapy, Avalere reported.