UPhA Powerpoint MTM -...
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4/10/15 1 History of MTM Medica0on Therapy Management Legisla0ve and Regulatory Highlights Megan Jolley Milne, PharmD, BCACP Disclosures “I declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, and stock holdings.” The Utah Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. Learning Objec0ves At the conclusion of this program, the par0cipa0ng pharmacist or technician will be able to: • Describe the history of MTM through its laws and regula0ons. • Compare MTM’s regulatory history to that of other regula0ons that affect the prac0ce of pharmacy. • Outline ways that pharmacists and other par0cipants can advocate on their own behalf to improve the prac0ce of pharmacy.
Transcript of UPhA Powerpoint MTM -...
4/10/15
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History of MTM Medica0on Therapy Management
Legisla0ve and Regulatory Highlights
Megan Jolley Milne, PharmD, BCACP
Disclosures
“I declare no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, and stock holdings.”
The Utah Pharmacy Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
Learning Objec0ves
At the conclusion of this program, the par0cipa0ng pharmacist or technician will be able to:
• Describe the history of MTM through its laws and regula0ons.
• Compare MTM’s regulatory history to that of other regula0ons that affect the prac0ce of pharmacy.
• Outline ways that pharmacists and other par0cipants can advocate on their own behalf to improve the prac0ce of pharmacy.
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Timeline of MTM History
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Medicare Moderniza0on Act of 2003
• Part D created • MTM is born • Statute:
• MTM is designed to promote • Enhanced enrollee understanding • Increased enrollee adherence • Detec0on of adverse drug events
• May be furnished by a pharmacist
Asheville Project
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pre
pre
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2005: What is MTM?
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hRp://www.pharmacist.com/mtm J Am Pharm Assoc. 2005;45(5):566-‐72
2006: Part D Begins
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2008
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J Am Pharm Assoc. 2008;48:341–353
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Part D Manual
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Chapter 7 Part D Manual
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True or False?
• Medicare Part D plans must reimburse retail pharmacists to perform MTM comprehensive medica0on reviews for pa0ents in their pharmacy.
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MTM in Part D
Part D plans choose MTM features: • Who?
• In-‐house or network • What?
• # Medical condi0ons • Which?
• Medical condi0ons ≥ 5/9
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• How much? • # Rx Claims • Chronic
• When? • Frequency of targe0ng
• Min. quarterly
MTM Eligibility
Rx Claims # Rx Dx
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• Part D only • Must reach threshold
• 2015: $3,138 • Divided by frequency of iden0fica0on • Ex: quarterly ID = $785 in last quarter
• Plans can limit to chronic or specific classes
MTM Eligibility
Rx Claims # Rx Dx
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• Plan sets minimum: ≥2 or ≤8 Rx
• Issue • Nonadherence
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MTM Eligibility
Rx Claims # Rx Dx
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• 2 or 3 Chronic Diseases • Plan can limit this to a specific list
• At least 5 of Core list: • Alzheimer’s • Arthri0s (OA, RA) • Osteoporosis • CHF • DM
• Dyslipidemia • ESRD • HTN • Bipolar • Chronic Mental Health
• Depression • Schizophrenia • Chronic Lung Disorder • Asthma • COPD
2010 -‐ Affordable Care Act
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CMS Standardized Format
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Medicare Part D 2014 Timeline
January 2014 CMS proposes sweeping changes for Part D
February 2014 CMS releases dral 2015 call leRer that builds upon proposed changes in proposed rule
March 7, 2014 Comments for proposed rule and dral call leRer due
March 10, 2014 CMS announces rescission of most of Part D proposed rule
April 7, 2014 CMS publishes final 2015 Call LeRer
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Used with permission from AMCP
MTM Payment
Part D Admin
Budget
Overhead
MTM
In-‐House Pharmacist
Third-‐Party MTM
Pharmacy Rx Budget Rx
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Medicare Part D 2014-‐2015 Timeline
May 2014 CMS releases final rule for 2015 without most controversial provisions
January 2015 CMS releases final rule for 2016 without many of the controversial provisions from the proposed rule
February 2015 CMS releases dral 2016 call leRer and does not include the controversial provisions
March 6, 2015 Comments due to CMS on the 2016 dral call leRer
April 6, 2015 Final call leRer release
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Used with permission from AMCP
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Medicaid States with MTM*
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Blue = state with MTM legisla0on *Not a comprehensive list
MTM Research Review • Evidence of improvement of health outcomes is insufficient: • Inconsistency • Imprecision
• Low quality evidence support improved: • Medica0on appropriateness • Adherence • Medica0on costs • Hospitaliza0on costs
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Viswanathan M, et al. JAMA Intern Med. 2015;175(1):76-‐87.
Pharmacist Providers -‐ H.R. 592
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MTM Payment
Part D Admin
Budget
Overhead
MTM
In-‐House Pharmacist
Third-‐Party MTM
Pharmacy Rx Budget Rx
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Part B
Provider Legisla0on Ini0a0ve
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Need More Informa0on?
Megan Jolley Milne, PharmD, BCACP [email protected]
Resources: Academy of Managed Care Pharmacy hRp://www.amcp.org/MTMResources/
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American Pharmacists Associa0on MTM Central www.pharmacist.com/mtm
www.pharmacistsprovidecare.com • • •
Center for Medicare and Medicaid Services hRp://www.cms.gov/Medicare/Prescrip0on-‐Drug-‐Coverage/
Prescrip0onDrugCovContra/MTM.html
