Gray Cori, Cooke Catherine E, Brandt Nicole
Pharmacy student, University of Maryland School of Pharmacy, Baltimore.
Research Associate Professor, Department of Pharmacy Practice & Science, University of Maryland School of Pharmacy.
Am Health Drug Benefits. 2019 Sep;12(5):243-251.
In 2006, the Centers for Medicare & Medicaid Services (CMS) implemented the newly established Medicare Part D program that required plan sponsors to offer a medication therapy management (MTM) program. The MTM program requirements have become more prescriptive over the past decade in the attempt to address low beneficiary enrollment rates, improve the quality of services provided, and address gaps in meeting the needs of enrollees.
To describe changes to the requirements for the Medicare Part D MTM program since its inception in 2006 and the impact of these changes to inform future program enhancements.
We obtained publicly available information extracted from the Medicare Part D MTM program fact sheets for the years 2008 through 2018, in addition to searching indexed literature through PubMed and additional literature through Internet searches. We then categorized the program's requirement changes annually, and described the Part D MTM program characteristics and reported statistics.
Significant changes to the Part D MTM program requirements occurred in 2010, 2013, and 2016 regarding eligibility criteria, MTM services, and reporting requirements. Thresholds to determine beneficiary eligibility have been lowered. Specific MTM services now include an annual comprehensive medication review, followed by a written summary using the Standardized Format. Quarterly targeted medication reviews are also required. Reporting requirements now include comprehensive medication review completion rates and the number of prescriber interventions, among others. Despite more prescriptive MTM program requirements, the low utilization of the MTM program continues.
Low beneficiary enrollment rates in the Medicare Part D MTM program led CMS to lower thresholds required for eligibility to expand the beneficiary pool. More prescriptive MTM service requirements enhanced service standardization. Despite these changes, MTM enrollment and comprehensive medication review rates remain low, likely, in part, from a lack of financial incentives. The Enhanced MTM program is a 5-year test model that is providing participating Part D plans regulatory flexibility and financial incentives to design their own MTM programs, to evaluate the impact of different program designs on beneficiary engagement and outcomes.
2006年，美国医疗保险和医疗补助服务中心（CMS）实施了新设立的医疗保险D部分计划，该计划要求计划赞助商提供药物治疗管理（MTM）计划。在过去十年中，MTM计划的要求变得更加具体，旨在解决受益人参保率低的问题，提高所提供服务的质量，并弥补在满足参保人需求方面的差距。
描述医疗保险D部分MTM计划自2006年设立以来要求的变化，以及这些变化的影响，以为未来的计划改进提供参考。
我们获取了从2008年至2018年医疗保险D部分MTM计划情况说明书中提取的公开信息，此外还通过PubMed搜索了索引文献，并通过互联网搜索了其他文献。然后我们每年对该计划的要求变化进行分类，并描述D部分MTM计划的特点和报告的统计数据。
2010年、2013年和2016年，在资格标准、MTM服务和报告要求方面，D部分MTM计划的要求发生了重大变化。确定受益资格的门槛已经降低。具体的MTM服务现在包括年度综合药物审查，随后是使用标准化格式的书面总结。还需要进行季度针对性药物审查。报告要求现在包括综合药物审查完成率和开处方者干预次数等。尽管MTM计划的要求更加具体，但MTM计划的利用率仍然很低。
医疗保险D部分MTM计划中受益人参保率低导致CMS降低了资格所需的门槛，以扩大受益人群体。更具体的MTM服务要求提高了服务标准化程度。尽管有这些变化，MTM参保率和综合药物审查率仍然很低，部分原因可能是缺乏经济激励措施。强化MTM计划是一个为期5年的测试模式，为参与的D部分计划提供监管灵活性和经济激励措施，以设计自己的MTM计划，评估不同计划设计对受益人参与度和结果的影响。
