Do medication therapy management (MTM) programs required by the Centers for Medicare & Medicaid Services for eligible Medicare Part D beneficiaries actually achieve their goals of demonstrating optimal outcomes?
Two poster presentations addressed this question, resulting in different findings. One presentation came from a team of pharmacists led by Sejal V. Patel, PharmD, at the Kelsey-Seybold Clinic, Houston, TX, who analyzed claims data to compare adherence rates and cost trends in patients with diabetes and an MTM program and a control group of diabetic patients without MTM. Overall, both cohorts demonstrated an adequate adherence level, but the adherence ratio did not differ significantly among the MTM enrollees (0.87) and those not enrolled in an MTM (0.88). However, among adherent members, the average drug cost per member per month (PMPM) was $44.16 for MTM enrollees and $26.90 for the non-MTM members. Similarly, the PMPM drug costs for nonadherent patients were $34.98 for MTM members and $17.86 for non-MTM members.
Dr Patel and colleagues suggested that these gaps can reflect that MTM enrollees “generally take a higher number of medications and have more chronic conditions than non-MTM members.” In fact, they pointed out, these data suggest “that MTM members may have started with a lower adherence rate and were faced with complex barriers to attain a PDC [proportion of days covered] greater than 80%.”
A second team of pharmacists, led by Wendy L. Sui, PharmD, of Blue Cross of California, evaluated the impact of a health-plan–sponsored MTM program on medication persistence, cost, and utilization. Their findings showed a trend of cost-savings with the MTM program for patients with chronic diseases (eg, diabetes, hypertension, asthma), as well as for the health plan, and a decrease in medical utilization, especially inpatient admissions and length of hospitalization. Dr Sui and colleagues noted that this review of the MTM program also brought to light issues of medication nonpersistence, gaps in care, and gaps in patients’ knowledge about their medications that should be addressed by the plan sponsor. They suggested that plan sponsors should continue to evaluate their MTM programs to address such challenges and prepare for impending legislative changes to these plans.