Medication therapy management (MTM) can improve health care and lower medical costs, and eligibility criteria should be modified make MTM services available to more Medicare beneficiaries, according to an article in the January issue of the Journal of Managed Care Pharmacy.


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Research backs expanded Medicare eligibility for MTM

January 15th, 2014

ARLINGTON, Va. – Medication therapy management (MTM) can improve health care and lower medical costs, and eligibility criteria should be modified make MTM services available to more Medicare beneficiaries, according to an article in the January issue of the Journal of Managed Care Pharmacy.

Laura Miller, senior economist for the National Association of Chain Drug Stores, co-authored the article, titled "Should Eligibility for Medication Therapy Management be Based on Drug Adherence?"

MTM services would reach more patients with a history of not taking their medications properly if eligibility requirements were changed to include Medicare Part D beneficiaries who take two prescription drugs, according to the article. Patients must take eight prescription medications to be eligible for MTM services under most Part D plans.

"Our findings suggest that current MTM eligibility criteria are not optimally targeted to capture underuse of and poor adherence to evidence-based medications for prevalent chronic diseases in the elderly," the article stated.

NACDS noted that the MTM article adds to a growing body of evidence that better medication adherence enhances patient health and lowers health care costs. Reports by the Congressional Budget Office and the Centers for Medicare & Medicaid Services (CMS), as well as articles in Health Affairs and the Journal of American Pharmacists, also illustrate that appropriate medication use can improve health outcomes and mitigate expenses.

Lawmakers, too, are sharpening their focus on MTM, including initiatives to refine eligibility criteria for MTM services in Medicare. NACDS said bipartisan support is growing for the Medication Therapy Management Empowerment Act of 2013 (H.R. 1024 and S. 557), co-sponsored by 159 members of the House of Representatives and 30 members of the Senate, representing more than 35 percent of the Congress.

According to NACDS, CMS also projects that MTM eligibility changes included in its Medicare Part D proposed rule published last week could increase the number of eligible beneficiaries from 2.5 million to 18 million.

"These efforts by Congress and the administration to improve access to MTM are good public policy and wise strategies for improving the quality and cost-effectiveness of public health," NACDS president and chief executive officer Steve Anderson said in a statement. "Pharmacists are widely trusted health care professionals with extensive education. They are trained medication specialists who work collaboratively with physicians and with other health care professionals to help patients use medicines safely and stay healthy."

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