Medicare Part D Enhanced Medication Therapy Management Model Test

By Ken Perez, Vice President of Healthcare Policy, Omnicell

On September 28, the Centers for Medicare and Medicaid Services (CMS) announced the Medicare Part D Enhanced Medication Therapy Management (MTM) Model Test, which gives prescription drug plans (PDPs) greater flexibility and financial incentives to provide MTM services to Medicare Part D members. MTM includes a range of services provided by pharmacists to help patients gain the most benefit from drug therapy.

The model is slated to begin on January 1, 2017, with the initial test performance period due to last five years, thru 2021, though CMS’s Innovation Center will continue to make performance-based payments for two years after the model performance period. The model test will be conducted in five of the 34 U.S. Part D Regions spanning 11 states.

Key elements of the model include:

  • Allowing PDPs to risk stratify their enrollee populations with respect to medication-related risk and to offer different levels and types of MTM services, as well as cost sharing assistance for financially needy enrollees when this poses a barrier to access, instead of providing the same level to all targeted individuals.
  • PDPs will also have the flexibility to experiment with alternative documentation—beyond the standardized Comprehensive Medication Review (CMR) format—to improve beneficiary and provider communication and engagement.
  • The financial incentives will include a direct prospective payment to PDPs to support the cost of the expanded MTM interventions as well as a performance payment to plans that are successful in improving outcomes and reducing Medicare Part A and/or Part B expenditures.

In short, the Part D Enhanced MTM Model is designed to test changes to the Part D program that would achieve better alignment of PDP sponsor and government financial interests, while also creating incentives for robust investment and innovation in better MTM targeting and interventions. This program indicates the federal government’s commitment to improving medication adherence and promoting MTM through greater beneficiary engagement.

Related Articles

Read a post about the model in the Health Affairs blog.


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