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From Health Law Daily, October 21, 2015

MTM improvements get across the board support in House subcommittee

By Melissa Mitchell, J.D.

Five witnesses, all of which were in support of the newly announced Enhanced Medication Therapy Management (MTM) program, testified in front of the House Energy and Commerce Committee’s Subcommittee on Health. The witnesses focused on what is necessary to do to ensure the enhanced program is more successful than the original program was in the past and highlighted the need to target patients that have the most need for the program.

MTM program. The MTM was created at the time of the formation of the Medicare Part D program pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) (P.L. 108-173). According to the Subcommittee, the goal of the MTM is “to ensure that covered Part D drugs are appropriately used to optimize therapeutic outcomes through improved medication use for beneficiaries enrolled in standalone Prescription Drug plans and Medicare Advantage Prescription Drug Plans.” In an attempt to more effectively use the MTM, CMS announced a new enhanced MTM model on September 28, 2015. According to CMS, the new model will attempt to use the program more effectively while at the same time improving health care outcomes and quality and lowering health care costs (see CMS announces Enhanced MTM model, hopes to bring efficiency to Part D, September 28, 2015).

The purpose of the Subcommittee’s hearing was to explore possible improvements for the MTM program. A press release for the hearing noted “as it functions currently, [the MTM program’s] incentives are not aligned and adherence to prescriptions is not as strong as possible.”

CMS testimony. Tim Gronniger, Director of Delivery System Reform for CMS, described the MTM program participation this way: “At the start of the Part D program, we believed that 25 percent of enrollees would qualify for MTM services. While CMS has made changes to the MTM program over the history of the Part D program in an effort to improve the efficacy of and beneficiary participation in the program, MTM program participation remains very low.” The Enhanced MTM model grew out of the desire to improve that participation.

According to Gronniger, the new model includes many new characteristics, including the following: (1) the availability of different MTM services based on the individuals level of need; (2) the availability of a more expansive set of MTM related items and services; (3) alternative communication systems put in place to improve beneficiary, pharmacist, and provider coordination; (4) opportunities to qualify for performance payments; and (5) a data collection effort.

Other witnesses. S. Lawrence Kocot, the Principal and National Leader for the Center for Healthcare Regulatory Insight, agreed with Gronniger’s opinion on the history of the program as he stated in his written testimony that “although many believed the MTM program would optimize the value of pharmaceutical for Medicare beneficiaries enrolled in Part D, the program has not lived up to expectations.” Yet, Kocot also testified that the Enhanced MTM program would be a “critical first step” for aligning prescription drug plan sponsors’ interests and governmental interests. Similarly, the President and CEO of the Pharmaceutical Care Management Association, Mark Merritt, said that the new model can provide “the tools and flexibility to improve the program,” and encouraged Congress to “support the implementation of the Model and allow it the time and space to generate better outcomes in Part D.”

Representing Rite Aid Corporation, Jesse McCullough, Director of Field Clinical Services, told the Subcommittee that Rite Aid “applauds the testing of the Enhanced MTM models of care,” yet noted since the model is only scheduled to last five years, “Rite Aid urges lawmakers to explore new and innovative approaches to improving the MTM program that could be implemented in the short term.” Dr. Richard Benson, the Associate Medical Director of Stroke at the MedStar Washington Hospital Center, expressed that he was “particularly pleased that the model will provide incentives to support more extensive MTM interventions, services, and care coordination among both prescribers and pharmacists; allow prescription plans to request beneficiary-level Parts A and B claims data; and support new MTM encounter data collection efforts.”

Key characteristics. When questioned about the key characteristics of a successful MTM model, most of the witnesses from the industry also gave similar answers, focusing on the necessity of identifying the right beneficiaries that could benefit from the program. Kocot specifically said in addition to “letting the model work” we have to do more to engage patients and to explore new ways to do so. Targeting patients with the most needs and offering rewards on the back end are “two very good starting points” according to Kocot. Merritt described the key to an effective program was “to let innovation start working” and to improve coordination between plans, providers, prescribers, and patients. Benson added that the ideal MTM model would “embrace health care wellness and not illness.”

Companies: MedStar Washington Hospital Center; Pharmaceutical Care Management Association; Center for Healthcare Regulatory Insight; Rite Aid Corporation

MainStory: TopStory ReimbursementNews DrugNews HouseNews CMSNews DrugBiologicNews PartDNews PrescriptionDrugNews

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