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Medication Therapy Management Part D Programs PowerPoint Presentation

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Description : This presentation on Medication Therapy Management Part D Programs was created by the School of Pharmacy Relations Committee for AMCP. This presentation tries to describe the key components of a medication therapy management Part D program, list the current eligibility criteria and program requirements and discuss the value of medication therapy management programs within health care and the role of the pharmacist.

Tags : Managed Care Pharmacy, healthcare, Academy of Managed Care Pharmacy, pharmacists, Managed Care Organizations, Student Pharmacist, Medication Therapy Management, Part D, Prescription Drug, Benefit

Published on : Jul 01, 2020 | Views : 1800 | Downloads : 1

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Slide 1-

Medication Therapy Management Part D Programs Created by the School of Pharmacy Relations Committee for AMCP Updated: March 2020
Slide 2-

Objectives Describe the key components of a medication therapy management Part D program List the current eligibility criteria and program requirements Discuss the value of medication therapy management programs within health care and the role of the pharmacist
Slide 3-

Medicare Modernization Act of 2003 Each Part D sponsor is required to have a MTMP (medication therapy management program) in their benefit for Part D Medicare beneficiaries Title 42 CFR Part 423 , Subpart D establishes requirements for Medicare Part D Medication Therapy Management Programs (MTMP) for Part D sponsors CMS Part D MTMP requirements are associated with cost control and quality improvement
Slide 4-

Requirements for MTMP Under 423.153(d), a Part D sponsor must have an established MTM program that: Ensures optimal therapeutic outcomes for targeted beneficiaries through improved medication use Reduces the risk of adverse events Is developed in cooperation with licensed and practicing pharmacists and physicians Describes the resources and time required to implement the program if using outside personnel and established the fees for pharmacists or others May be furnished by pharmacists or other healthcare providers May distinguish between services in ambulatory and institutional settings Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIPP)
Slide 5-

Sponsors of Part D MTMPs Annually each sponsor submits their program description to CMS for review and approval Sponsors must meet the MTMP requirements outlined by CMS guidance that can change each year
Slide 6-

Goals of MTMP Ensure that medications and supplements are utilized appropriately by targeted beneficiaries to optimize therapeutic outcomes through improved medication use Reduce the risk of adverse events, including adverse drug interactions, for targeted beneficiaries Minimize polypharmacy, duplication of medicines and unnecessary prescribing Promote collaboration with the patient, physician and other healthcare team members to develop and achieve optimal goals of medication therapy
Slide 7-

MTMP Requirements Program must target beneficiaries who are enrollees in the sponsor’s Part D plan and who: Have multiple chronic diseases, AND Are taking multiple Part D drugs, AND Are likely to incur annual costs for covered Part D drugs that exceed a predetermined level specified by the Secretary
Slide 8-

Qualified CORE Chronic Diseases Alzheimer’s Disease Bone Disease – Arthritis Rheumatoid Arthritis Osteoporosis Osteoarthritis Chronic Heart Failure Diabetes Dyslipidemia End Stage Renal Disease Hypertension Mental Health Depression Schizophrenia Chronic/Disabling Mental Health Conditions Bipolar Disorder Respiratory Diseases Asthma COPD Chronic Lung Disorders
Slide 9-

MTMP Enrollment Sponsors must enroll targeted beneficiaries using only an opt-out method of enrollment Therefore the beneficiary is auto-enrolled and must decline the service or opt out of the program Beneficiaries are targeted for enrollment at least quarterly during each year
Slide 10-

Minimum Level of MTM Services Must have an interactive component of MTM as well as continued monitoring and follow-up May incorporate passive or‘lower touch’ interventions, such as educational newsletters, drug utilization review (DUR) edits, refill reminders, and medication lists into their MTM programs, but these cannot be the sole offerings.
Slide 11-

MTM Services Each beneficiary must be offered an annual comprehensive medication review (CMR) Beneficiary must be provided a summary of the interactive consultation and an individualized written “take-away” Personal medication record, reconciled medication list, action plan, plan for monitoring, education, or self-management.
Slide 12-

MTM Services For ongoing monitoring, sponsors must provide targeted medication reviews, no less often than quarterly, to assess medication use since the CMR Should monitor whether: any unresolved issues need attention new drug therapy problems have arisen if the beneficiary has experienced a transition in care Can be person-to-person and/or system generated and include follow-up interventions when necessary
Slide 13-

Measuring the Outcome of the MTMP Part D sponsors must measure and analyze MTMP outcomes Sponsors must provide certain reports to CMS and in turn CMS releases an overview of MTM programs to the public Outcomes include medication adherence, medication persistence, drug-drug interactions identified, number of high-risk medications changed, polypharmacy, overutilization, medication issues resolved, overall prescription drug costs, overall healthcare costs impacted
Slide 14-

MTM Providers MTM services are commonly provided by a PBM or health plan, MTM vendor, and/or community pharmacists contracted with the sponsor or MTM vendor May be done by pharmacists or other qualified providers Sponsors must outline the program to CMS if using outside personnel and establish the fees for pharmacists or others providing the services Including specific fees, billing methods such as per minute or per service
Slide 15-

Summary MTM requirements are outlined by CMS and may change annually Part D sponsors are required to meet the minimum level of MTM services MTM providers can be pharmacists and other health care professionals The goal of MTM is to improve medication therapy regimens
Slide 16-

References Medicare Modernization Act of 2003 (MMA) under title 42 CFR Part 423, Subpart D §422.4 (a)(3) CMS Memo on April 5, 2019, “CY 2020 Medication Therapy Management Program (MTMP) Guidance and Submission Instructions.” https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/MTM https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/RxContracting_ReportingOversight
Slide 17-

To improve patient health by ensuring access to high-quality, cost-effective medications and other therapies. Mission & Vision

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