The Part D Enhanced Medication Therapy Management (MTM) model tests whether providing Part D sponsors with additional payment incentives and regulatory flexibilities promotes enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. The model is an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen health care system linkages.
Initiative Details
According to CMS Innovation, the Enhanced MTM has a five-year performance period that began January 1, 2017. CMS is testing the model in 5 Part D regions: Region 7 (Virginia), Region 11 (Florida), Region 21 (Louisiana), Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming), and Region 28 (Arizona). Participating basic stand-alone PDPs in these regions, upon approval from CMS, can vary the intensity and types of MTM items and services based on beneficiary risk level and seek out a range of strategies to individualize beneficiary and prescriber outreach and engagement. Participants can accomplish these goals by leveraging the core competencies of their own organizations, and of their network pharmacy providers, with those of medical prescribers to accurately identify and effectively intervene with all beneficiaries whose issues with medication management have caused, or are likely to cause, adverse outcomes and/or significant non-drug program utilization and costs. Participants for the model were chosen in August 2016 and the model is not currently accepting new applicants.
Questions regarding the Part D Enhanced MTM model may be directed to EnhancedMTM@cms.hhs.gov.
Medication Therapy Management programs for complex health needs
If you’re in a Medicare drug plan and take medications for different medical conditions, you may be eligible for a free Medication Therapy Management (MTM) program. This program helps you and your doctor make sure that your medications are working to improve your health.
Through the MTM you’ll get:
- A comprehensive review of your medications and the reasons why you take them.
- A written summary of your medication review with your doctor or pharmacist.
- An action plan to help you make the best use of your medications (there will be space for you to take notes or write down any follow-up questions.)
A pharmacist or other health professional will talk with you about:
- Whether your medications have side effects
- If there might be interactions between the drugs you’re taking
- Whether your costs can be lowered
- Other problems you’re having
It’s a good idea to schedule your medication review before your yearly wellness visit, so you can talk to your doctor about your action plan and medication list. Bring your action plan and medication list with you to your visit or anytime you talk with your doctors, pharmacists, and other health care providers. Also, take your medication list with you if you go to the hospital or emergency room.Â
If you take many medications for more than one chronic health condition, contact your drug plan to see if you’re eligible for a Medication Therapy Management program.
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