NCOA: Medication therapy management programs ‘severely underutilized’

Helping seniors juggle dozens of prescriptions and treatments for multiple chronic illnesses often takes the concerted efforts of professional caregivers, family members and the residents themselves. Yet medication therapy management (MTM) programs are one of the most "severely underutilized" Medicare benefits, notes a National Council on Aging fact sheet released this week.

MTM programs, offered by many insurers including Medicare, can provide important safety checks on drug interactions, redundant medications and cross-purpose medications. Since MTM programs involve a face-to-face discussion between a resident and a qualified pharmacist or doctor, the personalized review can catch issues of nonadherence, encourage residents to ask questions about their medications and uncover cases where a drug may be mimicking the symptoms of a disease, such as dementia.

Medicare’s MTM program is free for Part D beneficiaries who meet three basic federal requirements:

  1. must have multiple chronic conditions
  2. must be taking at least two Part D medications
  3. must be likely to have out-of-pocket drug expenses exceeding $3,017 in 2014.

In addition to the federal requirements, Part D plans can choose to target certain chronic diseases and/or require a higher number of medications. Residents who are enrolled in a Part D plan should find out what criteria are required by the plan to take advantage of the MTM program.

The Centers for Medicare & Medicaid Services (CMS) estimated in 2006 that about one-quarter of Part D beneficiaries would qualify for the free MTM service. Yet only about 10 percent of those eligible have participated. In January, CMS proposed an expansion to the Part D MTM program, hoping to increase participation.

To learn more, see CMS’ MTM page.


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