In an effort to standardize the provision of medication therapy management (MTM) within Medicare Part D, CMS has outlined specific requirements for Part D Plan MTM programs in 2010. The APhA’s Medication Therapy Management Digest (March 2010) reviews these requirements.
MTM programs must:
- Enroll targeted beneficiaries using an opt-out method only (i.e., beneficiaries are automatically enrolled unless they choose not to be)
- Target beneficiaries for enrollment at least quarterly.
- Include the following enrollment criteria for targeted beneficiaries:
- Does not require more than three chronic disease states.
- Does not require more than eight medications.
- In defining multiple chronic diseases, sponsors must target at least four of seven core chronic disease states.
- Likely to incur annual costs of $3,000 for covered Part D drugs (a reduction from the previous requirement of $4,000).
Part D plans’ MTM programs must include, at a minimum:
- An annual comprehensive medication review, including a review of medication use, interactive person-to-person consultation (face-to-face or by phone), and a written summary.
- Quarterly targeted medication reviews.
- Active interventions (i.e., not limiting interventions to mailings and refill reminders).
Plans must measure and report the number of:
- Comprehensive MTM visits.
- Targeted MTM visits.
- Provider interventions.
- Changes in therapy as a result of interventions.