Access to Care

Medication therapy management programs varied widely after initial implementation of the Medicare Part D drug benefit

The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) provided drug benefits for the first time to Medicare beneficiaries in the hope that better access to drugs would reduce use of emergency and other care, as well as hospitalizations. The MMA includes a Medication Therapy Management (MTM) program for persons with multiple chronic diseases who are on multiple long-term medications and likely to incur annual Part D Medicare drug costs over $4,000.

The Centers for Medicare & Medicaid Services (CMS) purposely left the MTM program requirements vague, allowing the marketplace to experiment and evolve. MTM programs implemented in the first few months of the Medicare Part D benefit varied widely in enrollment requirements and range of services offered, according to a new study.

Of the MTM programs offered, 90.5 percent restricted their enrollment based on a person's number of diseases, with a median of three diseases required; 57.1 percent restricted enrollment based on the type of chronic condition; and 95.2 percent had requirements for the number of medications (median of six) necessary for program enrollment.

The most frequently provided MTM services were patient education (75 percent of programs), medication adherence (70 percent), and medication review (60 percent). In-house telephone call centers were the most common method of providing MTM services, used by 90.4 percent of programs, followed by mailed interventions, which were used by 76.1 percent of MTM programs.

However, these types of interventions lacked empirical justification. As best practices are identified, the benefit will certainly become more prescriptive and restrictive in the coming years, note Daniel R. Touchette, Pharm.D., M.A., of the University of Illinois at Chicago, and colleagues. Their findings were based on a survey of MTM benefit plan managers of 70 randomly selected health plans covering 12.1 million Medicare beneficiaries throughout the United States.

The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-2005-0038) as a part of the DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) program. More details are in "Survey of medication therapy management programs under Medicare part D," by Dr. Touchette, Anne L. Burns, B.Pharm., Marcie A. Bough, Pharm.D., and Juan C. Blackburn, M.D., M.B.A., M.P.H., in the November 2006 Journal of the American Pharmaceutical Association 46(6), pp. 683-691.

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