Read it and weep. Another example of grand ideas and good intentions gone unfulfilled. What is most disturbing is that there are scores of similar initiatives to manage health care costs within the Affordable Care Act all of which are being counted on to make health care “affordable” and to raise the quality of care.
Each of these initiatives face the headwinds of human behavior and bureaucracy.
A new analysis from Avalere Health finds that less than half of all Medicare prescription drug (Part D) enrollees eligible for medication therapy management (MTM) programs receive these services. Under Medicare rules, the Centers for Medicare & Medicaid Services (CMS) requires all Part D plans to provide MTM services to beneficiaries who meet certain criteria and have high drug utilization.
MTM services involve providing high-utilizing beneficiaries with a complete review of their medication regimens by a clinical pharmacist in order to provide education, improve adherence, and detect adverse drug events or inappropriate medication use.
Specifically, CMS estimates that 25 percent of beneficiaries are eligible for MTM (2010 Medicare Part D MTM Programs Fact Sheet). Yet, only 11 percent of all Part D enrollees were part of a MTM program in 2012.
“With only half of enrollees eligible for MTM programs receiving benefits, the Avalere analysis shows that these valuable services are under-used in Medicare,” said Dan Mendelson, CEO of Avalere Health. “As regulators consider reforms, they will need to balance access to services with the operational realities faced by health plans.”
In 2012, Part D beneficiaries who had at least two chronic conditions, take at least three medications, and have annual drug spending of more than $3,100 were eligible for MTM services. MTM programs are intended to optimize therapeutic outcomes through improved medication adherence and reduced risk of adverse events such as drug-drug interactions or clinically inappropriate therapies. In addition to offering eligible beneficiaries MTM services, Part D plans are required to offer all MTM enrollees a comprehensive medication review (CMR).
via Avalere Health : Few Medicare Beneficiaries Receive Comprehensive Medication Management Services.
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