United, WellCare, Humana, Blues plans, CVS to participate in new Medicare Part D model

drugs medicine pharmacy

The federal government has named six Part D sponsors that are participating in its Enhanced Medication Therapy Management Model, which is set to begin next year.

The six participants--Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield Northern Great Plains, CVS Health, Humana, UnitedHealthcare and WellCare Prescription Insurance--serve an estimated 1.6 million beneficiaries, the Centers for Medicare & Medicaid Services says in an announcement.

The Enhanced Medication Therapy Management (MTM) Model, which CMS debuted last fall, allows stand-alone Part D prescription drug plans in select regions to forgo the standard MTM model and instead create their own, CMS-approved programs to “optimize medication use, improve care coordination and strengthen system linkages.”

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To achieve that, the new model gives participating Part D plans flexibility--and payment incentives--to work with network pharmacy providers and prescribers to identify beneficiaries who have struggled with medication management and to design interventions that improve outcomes for those patients.

The experiments are needed, CMS says, because “evidence suggests that the MTM services currently offered by Part D plans fall short of their potential to improve quality and reduce unnecessary medical expenditures, most likely due to misaligned financial incentives and regulatory constraints.”

Indeed, a study published last month indicated that the current model gives plan sponsors too much liberty to decide eligibility requirements, resulting in low enrollment rates in MTM programs. The Enhanced MTM model shows promise, the study said, though it also argued Medicare Advantage Part D plans should be included in the model.

Starting Jan. 1, the five-year, Enhanced MTM model test will roll out across regions that include the following states: Virginia, Florida, Louisiana, Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming and Arizona. CMS selected the areas in hopes they would be “broadly representative of national market characteristics,” the announcement says.

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