NCPA Urges Congress, Medicare to Expand MTM Utilization

PRESS RELEASE

ALEXANDRIA, Va. (October 21, 2015) -- Medicare can achieve the dual goals of better health outcomes for the program’s beneficiaries and at lower overall costs if the medication therapy management (MTM) services of community pharmacists are better utilized, the National Community Pharmacists Association (NCPA) said today in comments submitted to a congressional committee.

As the House Energy and Commerce Subcommittee on Health conducted a hearing on MTM in the Medicare Part D program, NCPA proposed several enhancements to benefit patients and taxpayers alike.

"NCPA believes that prevention is the best medicine, and whether it’s catching a medication error before it leads to a hospitalization or effective chronic disease management, MTM services present an opportunity to improve patient care while providing greater efficiencies within the health care system,” said NCPA CEO B. Douglas Hoey, RPh, MBA. “The implementation of MTM by pharmacy benefit management (PBM) corporations is

ripe for review

. Rather than realize the

demonstrated benefits

of face-to-face MTM, some PBM corporations have taken a check-the-box approach and relegated the service to phone banks and mass mailings. NCPA strongly supports Medicare’s recent efforts to improve MTM services and will continue to work with Medicare officials and Congress toward that end.”

Many of the PBM corporations that have taken the check-the-box approach to providing this vital service have shown lower than expected clinical results, which accordingly have resulted in certain Part D plans receiving a lower star rating. As a result, many PBMs oppose the MTM program.

NCPA's comments cited Medicare and Congressional Budget Office data on the health and cost-saving benefits of MTM and offered a range of recommendations to get the most out of MTM.

Key suggestions include:

• The Centers for Medicare & Medicaid Services (CMS) should apply the findings from a recent internal review which concluded that the best-performing Part D organizations used MTM to improve medication adherence and quality of prescribing while keeping health care costs (including drugs) from rising.
• Congress should pass S. 776, the Medication Therapy Management Empowerment Act of 2015, which would expand MTM eligibility to beneficiaries with a single, specified chronic condition, and CMS should proceed with its proposal to broaden MTM coverage.
• MTM models should be adjusted to reward quality care outcomes, particularly as CMS transitions to a value-based reimbursement system.