Few eligible Part D enrollees receive drug therapy management

The Centers for Medicare & Medicaid Services requires that all Medicare Part D plans offer medication therapy management (MTM) to eligible consumers. But only 11 percent of those who are eligible for the service receive it, finds a new analysis from Avalere Health. 

To perform the analysis, Avalere, a Washington-based consulting and research firm, acquired plan data based on Part C and D requirements issued by CMS from 2012.

In 2012, Part D beneficiaries who met the criteria--they had at least two chronic conditions, were taking at least three medications and spent more than $3,100 on prescription drugs--became eligible for MTM services.

Avalere found level of participation in MTM programs varies across carriers. For the top 10 participating Part D carriers, MTM enrollment varied from a low of 4.6 percent to a high of 17.5 percent. During that time, CMS estimates that 25 percent of all Part D beneficiaries were eligible for MTM, but only 11 percent--less than half--of those who were eligible were part of an MTM program, according to the analysis.

Meanwhile, only about 1 percent of all Part D beneficiaries who are eligible for MTM received a comprehensive medication review, which Part D plans are also required to offer to that population.

The analysis shows that "these valuable services are under-used in Medicare," said Dan Mendelson, CEO of Avalere Health. "As regulators consider reforms, they will need to balance access to services with the operational realities faced by health plans," Avalere CEO Dan Mendelson said.

For more:
- here's the analysis