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
- Reducting Use of High-Risk Medication
- Patients with Diabetes
- Medication Adherence for Diabetes
- Medication Adherence for HTN
- Medication Adherence for Cholesterol
Three General Benefits to Pharmacies
- High-Valued Patient Retention
- Revenue Generation
- 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.