Note: This report is greater than 5 years old. Findings may be used for research purposes but should not be considered current.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 included a provision for programs, termed Medication Therapy Management (MTM) programs, focused on optimizing therapeutic outcomes for patient with multiple medications and multiple conditions. The broad definition of MTM program in this Act allowed Prescription Drug Plans (PDPs) and Medicare Advantage Drug Plans (MA-PDs) to develop a wide variety of MTM services. The purpose of this survey was to describe and summarize the enrollment criteria and benefit design for MTM programs being offered throughout the United States in 2006.
A 12-item survey with mostly open-ended questions was administered by phone to MTM benefit plan managers from lists obtained from CMS. Data was abstracted from the surveys and categorized after the responses were collected with the following research questions in mind: 1) What characteristics are required for a patient to be enrolled in an MTM program?; 2) What types of services are provided by MTM programs?; and 3) How are those MTM services being provided to patients? Results: Surveys were obtained from 70 health insurance plans covering 12.1 million Medicare enrollees, and representing 21 distinct MTM programs. 90.5% of MTM programs restricted their enrollment based on number of disease states, with a median of 3 (range 2-5). 57.1% of MTM programs restricted enrollment based on the type of chronic condition. 95.2% of MTM programs had requirements for the number of medications necessary for enrollment in the program, with a median of 6 (range 2-24) medications necessary. The most frequently provided MTM services were patient education (75.0% of programs), patient adherence (70.0%), and medication review (60.0%). The median number (range) of different service types provided by MTM programs was 3 (2-7). 76.1% of MTM programs used mailed interventions, 90.4% used in-house call centers, and 19.0% contracted with pharmacies to provide some or all of their MTM services.
MTM programs currently offered by PDP’s and MA-PD’s are highly variable. Definitive evidence supporting many of the most common interventions is lacking.