How Part D plan sponsors miss opportunities for cost-saving interventions


Medicare Part D's medication therapy management component has the potential to improve care and cut costs, but giving plan sponsors too much liberty to decide eligibility requirements can hamper these efforts.

Part D prescription plans must offer medication therapy management, but since plan sponsors can set their own eligibility criteria, enrollment rates in medication therapy management averaged just 10 percent in 2012, according to a recently published Health Affairs study.

For some plan sponsors, just 0.2 percent of enrollees with multiple chronic conditions and high prescription expenditures were enrolled in medication therapy management. On the other end of the range, for some health plans as many as 57 percent of eligible enrollees were signed up for medication therapy management.

Such drastic variation creates inequities in access to medication therapy management, and results in missed opportunities for interventions that might improve healthcare outcomes and reduce spending, the researchers argue.

There is hope for improvement, however, in the Centers for Medicare & Medicaid Services' new Medicare Part D Enhanced Medication Therapy Management model, which is set to begin in 2017 and run for five years, the study notes.

The authors question, though, why Medicare Advantage Part D plans (MA-PDs) are not included in the new model, noting that compared with standalone prescription drug plans, "MA-PDs currently have greater financial incentives to ensure the success of medication therapy management interventions."