title: Trends in Medicare Part D Medication Therapy Management Eligibility Criteria.
abstract: BACKGROUND
  To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized.
  
  
  OBJECTIVE
  To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs.
  
  
  METHODS
  This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008-2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans.
  
  
  RESULTS
  For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases.
  
  
  CONCLUSIONS
  The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans.
authors.affiliation: Professor, Health Outcomes and Policy Research, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis.
authors.forename: Junling
authors.initials: J
authors.lastname: Wang
authors.affiliation: Professor of Health Economics, and Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas M.D. Anderson Cancer Center, Houston.
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
authors.affiliation: Student, Duke University, Durham, NC, and was a summer intern at the University of Tennessee, College of Pharmacy, Memphis, at the time of this study.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Qin
authors.affiliation: Student, University of Mississippi School of Pharmacy, Jackson, and was a summer intern at the University of Tennessee College of Pharmacy, Memphis, at the time of this study.
authors.forename: Theo
authors.initials: T
authors.lastname: Young
authors.affiliation: Student, University of Tennessee College of Pharmacy, Memphis.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Thomas
authors.affiliation: Assistant Professor, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Spivey
authors.affiliation: Professor, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis.
authors.forename: David K
authors.initials: DK
authors.lastname: Solomon
authors.affiliation: Dean and Professor, University of Tennessee College of Pharmacy, Memphis.
authors.forename: Marie
authors.initials: M
authors.lastname: Chisholm-Burns
keywords: CMS guidance; MTM eligibility criteria; MTM enrollment; MTM thresholds; Medicare Part D plans; medication therapy management (MTM) program