Medicare Monday: Medication Therapy Management in Part D – Another Potential Opportunity for Savings

Over the past few weeks, we’ve discussed how Medicare Part D helps patients with a number of different conditions including Parkinson’s, artery plaque, congestive heart failure, chronic obstructive pulmonary disease and dehydration save, just by adhering to the medicines they get through their Part D plans. This week, we’re highlighting one way Medicare aims to improve the use of medications and adherence in Part D: medication therapy management (MTM).

MTM services are offered to certain Part D enrollees who meet eligibility criteria, such as taking multiple medicines or managing chronic conditions. The Centers for Medicare & Medicaid Services (CMS) describe MTM as “as a patient-centric, comprehensive approach to improve medication use, reduce the risk of adverse events, and improve medication adherence.”

A recent study in Health Affairs looked at medication adherence in Part D and how it relates to the Part D MTM program. The study found suboptimal adherence to medications is associated with significantly higher costs in Part A and B Medicare services among Part D enrollees with diabetes, heart failure and chronic obstructive pulmonary disease. Specifically, the extra Medicare costs associated with poor medication adherence ranged from $49 to $840 per month. 

While beneficiaries with poor adherence had higher costs, they were not more likely to be eligible for MTM services under Part D, which could potentially have helped improve their adherence. The researchers suggest there is an opportunity to better target Part D’s MTM program to enrollees who may incur preventable future health care costs.

Interested in learning more about strategies stakeholders are developing to improve adherence? Check out our new Ask About Adherence Blog Series. And stay tuned for more #MedicareMonday posts about the Part D program!