Continuing to expand Part D MTM for 2014

Draft CMS advance notice and call letter released; comments due March 1


Encouraging the expansion of Medicare Part D medication therapy management (MTM), CMS has issued the annual draft advance notice and call letter for 2014. Comments are due March 1, 2013.

As in past years, APhA will comment on CMS’s combined draft guidance document as a route to continue to improve Part D MTM programs and increase awareness of that benefit.

“Growing evidence of the value of MTM to improve beneficiaries’ therapeutic outcomes indicates that more beneficiaries may benefit from these services,” CMS wrote on page 149.

Improvements to promote beneficiaries’ awareness include developing a new MTM tab on the “Your Plan Details” page of the Medicare Plan Finder; adding MTM definitions to the general tabs and glossaries on; and requiring sponsors to have a dedicated “Medication Therapy Management Program” page linked from their Medicare drug plan website with specific information about their MTM program.

Additional highlights of the CMS draft document include the following:

  • 2014 Star Ratings that include 4-star thresholds related to medication adherence
  • PQA (Pharmacy Quality Alliance) measures for high-risk medications
  • Using MTM to promote the coordination of care
  • Optimizing the delivery of MTM in long-term care settings

CMS will release the final guidance, which is subregulatory, on April 1, 2013.

In related news, CMS has published a proposed rule on the medical loss ratio (MLR) requirements for Medicare Advantage and Part D programs—under the Affordable Care Act—that references MTM. Comments are due April 16, 2013.