Healthcare Consulting

Healthcare: Medication Therapy Management

Growth and Prominence of Medicare Part D

  • Centers for Medicare & Medicaid (CMS) has increased efforts to  pay differently for quality and value-based patient care.
  • Part D covered 26% of Rxs in US; 33% of all Rxs for Independents
  • 10,000 patients are aging into Medicare daily and they use an average of 2.5 Rxs/month.
  • 65+ population will more than double by 2050
  • Part D plans are required to offer MTM programs.
  • 2015, Part D plans are required to offer MTM services to patients with annual drug spends above $3,138.00
  • Part D plans are permitted to establish networks of “preferred pharmacies”.
  • Patients are incented to use “preferred networks” for lower co-pays.
  • Pharmacies receive lower co-pay from plans resulting in increased volume of patients.

Star Ratings & Health Plans

  • The program is designed to identify the best Medicare plans by ranking them with 1 to 5 Stars.
  • The goal is to make it easy for Medicare beneficiaries to compare plans – based on quality and cost.
  • CMS will favor “high performing plans” and have the ability to terminate low-performing plans.
  • Clearly, plans are seeking partners(Pharmacies) that help them with high Star Ratings.
  • Pharmacies rating = 48% of a Plan’s rating.

Star Ratings & Pharmacy

5 Medication-Use Measures

  1. Reducting Use of High-Risk Medication
  2. Patients with Diabetes
  3. Medication Adherence for Diabetes
  4. Medication Adherence for HTN
  5. Medication Adherence for Cholesterol

Three General Benefits to Pharmacies

  1. High-Valued Patient Retention
  2. Revenue Generation
  3. Star Ratings Improvement

Advantages & Challenges for Independent Pharmacies


  • Patients connect with pharmacists
  • Independent Pharmacies should leverage Personalized Service
  • Patients will favor pharmacies that deliver best care


  • Chain pharmacies have better MTM completion rates
  • Plans may exclude pharmacies from participating in a Part D plan’s preferred pharmacy network.

Level 10 Consulting pharmacists are experienced, MTM certified and licensed across selected state lines. Services are provided telephonically and/or face to face.

What Is Coaching
Areas For Coaching
Return on Investment

303 Perimeter Center North
Suite 300
Atlanta, GA 30346
Phone: 770-329-5757

John Maxwell Team