Eligibility For And Enrollment In Medicare Part D Medication Therapy Management Programs Varies By Plan Sponsor.
Medicare Part D prescription drug plans must offer medication therapy management to beneficiaries with multiple chronic conditions and high drug expenditures. However, plan sponsors have considerable latitude in setting eligibility criteria. Newly available data indicate that enrollment rates in medication therapy management among stand-alone prescription drug plans and Medicare Advantage drug plans averaged only 10 percent in 2012. The enrollment variation across plan sponsors-from less than 0.2 percent to more than 57.0 percent-was associated with the restrictiveness of their eligibility criteria. For example, enrollment was 16.4 percent in plans requiring two chronic conditions versus 9.2 percent in plans requiring three, and 12.7 percent in plans requiring the use of any Part D drug versus 4.4 percent in plans requiring the use of drugs in specific classes. This variation represents inequities in access to medication therapy management across plans and results in missed opportunities for interventions that might improve therapeutic outcomes and reduce spending. The new Part D Enhanced Medication Therapy Management model of the Centers for Medicare and Medicaid Services has the potential to significantly increase the impact of medication therapy management by aligning financial incentives with improvements in medication use and encouraging innovation.
Bruce Stuart is a professor of pharmaceutical health services research at the University of Maryland School of Pharmacy, in Baltimore.
Bruce
B
Stuart
Franklin B. Hendrick (fhend001@umaryland.edu) is a doctoral candidate in pharmaceutical health services research at the University of Maryland School of Pharmacy.
Franklin B
FB
Hendrick
Xian Shen is a doctoral candidate in pharmaceutical health services research at the University of Maryland School of Pharmacy.
Xian
X
Shen
Mingliang Dai is a doctoral candidate in gerontology at the University of Maryland, Baltimore.
Mingliang
M
Dai
Sarah E. Tom is an assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy.
Sarah E
SE
Tom
J. Samantha Dougherty is director of policy and research at Pharmaceutical Research and Manufacturers of America (PhRMA), in Washington, D.C.
J Samantha
JS
Dougherty
Laura M. Miller is a senior economist at the National Association of Chain Drug Stores, in Arlington, Virginia.
Laura M
LM
Miller
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics / Q000639:trends; D016208:Databases, Factual; D004608:Eligibility Determination / Q000191:economics* / Q000639:trends; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D008297:Male; D054524:Medicare Part D / Q000191:economics / Q000458:organization & administration*; D054539:Medication Therapy Management / Q000191:economics / Q000458:organization & administration*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
Medicare; Medicine/Clinical Issues