Medicare Part D Pharmaceuticals

CMS 2010 Requirements for Medicare Part D Plan MTM Programs

In an effort to standardize the provision of medication therapy management (MTM) within Medicare Part D, CMS has outlined specific requirements for Part D Plan MTM programs in 2010.  The APhA’s Medication Therapy Management Digest (March 2010) reviews these requirements.

MTM programs must:

  • Enroll targeted beneficiaries using an opt-out method only (i.e., beneficiaries are automatically enrolled unless they choose not to be)
  • Target beneficiaries for enrollment at least quarterly.
  • Include the following enrollment criteria for targeted beneficiaries:
    • Does not require more than three chronic disease states.
    • Does not require more than eight medications.
    • In defining multiple chronic diseases, sponsors must target at least four of seven core chronic disease states.
    • Likely to incur annual costs of $3,000 for covered Part D drugs (a reduction from the previous requirement of $4,000).

Part D plans’ MTM programs must include, at a minimum:

  • An annual comprehensive medication review, including a review of medication use, interactive person-to-person consultation (face-to-face or by phone), and a written summary.
  • Quarterly targeted medication reviews.
  • Active interventions (i.e., not limiting interventions to mailings and refill reminders).

Plans must measure and report the number of:

  • Comprehensive MTM visits.
  • Targeted MTM visits.
  • Provider interventions.
  • Changes in therapy as a result of interventions.

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