Drug Topics - December 10, 2007 - (Page 16)

16 DRUG TOPICS DECEMBER 10, 2007 www.drugtopics.com UNRAVELING MEDICARE Earlene Lipowski, Ph.D. Beneficiary participation in MTM services here was some uncertainty at the outset about whether the Medicare Part D program would attract an adequate number of health plans as participants. At the direction of Congress, CMS was careful not to offer plan premiums at levels that would discourage participation. There is no doubt that the number of plans that responded exceeded the most optimistic projections, indeed to the extent that there is now concern about too many options and too many choices. There also was concern about whether networks would ensure reasonable access to a range of pharmacy choices for Part D enrollees. As OIG recently reported, virtually all community pharmacies participate in at least some plans. Most pharmacies deal with all of the Part D As OIG recently reported, plans offered in their locale. Now some information is virtually all community available about eligibility and pharmacies participate participation in the medication therapy management in at least some plans. (MTM) programs that were a requirement of Part D. To meet the legal and regulatory requirements, MTM programs must be designed in cooperation with licensed and practicing physicians and pharmacists to ensure that covered drugs are appropriately utilized to optimize therapeutic outcomes and that treatment plans are designed to reduce the risk of adverse events. T porosis, osteoarthritis, and depression. Nearly half the plans offer a range of MTM services. Some MTM services are voluntary, and some plans give enrollees the opportunity to opt out. Overall, 10% of Part D enrollees met the criteria for MTM services offered by the PDP and MA plans in 2006. Twelve percent of those enrolled in PDP plans met criteria for MTM. The proportion was higher in the PDP plans because persons with greater healthcare needs tended to enroll in PDP plans rather than in MA programs. Two-thirds of those who met their plan’s criteria actually participated in MTM services. Thirty percent declined. The remainder, roughly 3%, participated but subsequently disenrolled from the MTM program. Pharmacist involvement While there still is a great deal of variation in the MTM programs for 2007, R.Ph. involvement has increased relative to the degree of pharmacist involvement in 2006. One-quarter of current Part D plans contract with outside personnel to provide MTM services and utilize nurses, diabetes educators, disease management specialists, consultant pharmacists, community R.Ph.s, and PBM employees. About one-half of the plans rely completely on in-house staff. The remaining one-quarter of MTM programs employ a combination of in-house and outside personnel. Plans are required to report the outcomes of their MTM programs to CMS every six months, and, not surprisingly, there is a range of methods for documenting and assessing outcomes. CMS requires that plans report a core set of indicators about MTM enrollment methods, including the number of beneficiaries who meet the criteria for MTM, the number who participated in the program, and the number who discontinued participation. The plans must also track the number of prescriptions and expenditures per person per month. Many Part D sponsors hope to capture additional outcomes, including overall healthcare expenditures, medication adherence, potential drug interactions, and patient satisfaction. Reports on MTM activities and outcomes from Jan. 1 through June 30 were due at the end of August. The reporting requirements will expand in 2008, and CMS will then begin a more detailed analysis of MTM programs and their outcomes. is associate professor, Department of Pharmacy Health Care Administration, University of Florida College of Pharmacy. THE AUTHOR Rules and regulations Regulations specify that MTM programs are appropriately directed to enrollees who have multiple chronic diseases, use multiple Part D drugs, and are likely to incur annual costs of $4,000 or more. However, plan sponsors have considerable flexibility in the design of their MTM programs. CMS reviewed 613 different MTM proposals for approval in 2007, each with its own procedures for identifying and enrolling eligible patients, offering different service providers and a variety of interventions. The intensity of the services proposed by the plans ranged from refill reminders to individual education sessions. The majority of plans screen either monthly or quarterly to identify those eligible for MTM according to the plan-specific criteria. Ninety percent of the programs focus MTM services on persons with one or more priority conditions—diabetes, heart failure, hypertension, asthma, COPD, dyslipidemia, rheumatoid arthritis, osteo- http://www.drugtopics.com

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Drug Topics - December 10, 2007 Latebreakers Latebreakers in Depth Letters Health-System Edition - Cover Story Clinical Practice Professional Practice Special Report Technology Community Practice Unraveling Medicare 150 Years of American Pharmacy Rx Care In the Pipeline Cover Story: Fair or foul? Self-Care Chains and Business Government and Law Continuing Education: Natural Medicines for Bone Health New Products Advertisers Index Classified Viewpoint

Drug Topics - December 10, 2007

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