CMS proposes rule expanding access to Part D MTM

Yesterday CMS released a 678-page proposed rule on “Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs,” which contains many changes to Medicare Part D. Some of those changes are great news for pharmacists and patients. 

The most exciting development is the expansion of medication therapy management (MTM) services for Medicare beneficiaries. Under the new provisions, MTM would be available to beneficiaries with two or more chronic conditions, with at least one being a core chronic disease, who are taking two or more covered Part D drugs (and these can be ANY Part D drugs), with at least a $620 drug spend annually. In fact, CMS said in the proposed rule that MTM has been “shown to improve drug therapy outcomes and decrease healthcare costs” and that “MTM programs strengthen the Part D program and improve its overall value.” CMS also explicitly linked MTM programs with quality care, noting that “5-star [Part D] plans have consistently made significant investments in MTM.”

We couldn’t have said it better ourselves. APhA has long championed the importance of MTM and appreciates CMS’s acknowledgment of the value of MTM as well as the vital contributions of pharmacists’ services to health care quality for patients!

While we believe that many aspects of the proposed rule will be favorable for pharmacists and their patients, there are a few potential areas of concern. We will be engaging with members in the coming weeks to garner your feedback and input for comments, which are due March 7, 2014.