Targeted Medication Review Key for Medication Therapy Management

August 02, 2019 - A Humana study comparing the differences in medication therapy management (MTM) services found that targeted medication reviews (TMR) were highly successful interventions.

“This study highlights how critically important it is for Part D and Medicare Advantage plans to continue to innovate in their efforts to contribute to better therapeutic outcomes for the patients they serve," Michael Taday, associate vice president of pharmacy clinical strategies and operations for Humana pharmacy solutions, said in a statement.

CMS has designated two medication therapy management interventions, comprehensive medication reviews (CMRs) and TMRs.

CMRs review all of the medications taken by a patient and sends them a cover letter, a full medication list, and a medication action plan to combine with their medications. CMS requires providers to offer CMRs to eligible patients on an annual basis.

TMRs monitor medications constantly to determine that drugs are appropriately prescribed and predict or identify medication-related problems.

READ MORE: How Payers Can Develop a Medication Therapy Management Program

The study determined that TMR interventions were more successful at achieving low acute inpatient admissions. Furthermore, patients were far more likely to adhere to their medications when their providers used a TMR. The past year in particular proved that TMR patients were less likely to visit the emergency department, the data showed.

In contrast, CMR interventions only reduced acute inpatient admissions when it was clear that the patient had a medication-related condition.

Although TMR interventions proved more effective, the researchers pointed out that Part D plans are disincentivized from using TMRs. CMS only rates Medicare Part D plans for their members’ CMR completions, not TMR completions.

However, these most recent study findings have led to Humana choosing to adopt TMR, not CMR, into its medication therapy management protocol.

Medication therapy management programs remain a part of payers’ programs. Most of the major payers have a medication therapy management program in some form, including various Blue Cross Blue Shield organizations, Cigna, and Aetna.

READ MORE: CMS Proposes Alternative Payment Models for Chronic Kidney Disease

Humana has been facilitating medication therapy management programs for years, including its RxMentor program, which sought to ensure medication adherence among members through safety education.

Humana’s study is the result of a CMS initiative called the Enhanced Medication Therapy Model. CMS is looking for new, innovative, targeted intervention models to improve medication therapy management in Medicare and Medicaid.

Before starting the model, the agency found evidence suggesting that medication therapy management led to medication adherence, cost savings for providers and patients, reduced adverse drug events, proper evaluation of a medication’s appropriateness and sourcing of therapeutic substitutions, and reductions in unnecessary hospitalizations.

It also is considered a way to build trust between pharmacists and patients to help enforce medication adherence.

To test these theories, CMS announced its Enhanced Medication Therapy Management Model in 2015. The model seeks new, cost-effective solutions to the current CMS Part D program’s approach to medication therapy management.

READ MORE: CMS Finalizes Medicare Advantage, Part D Payment Policies

The Enhanced Medication Therapy Management Model looks at the performance of plan benefit packages of prescription drug plans (PDP) in a Part D. Specifically, the agency will reward PDPs for a two percent or more decrease in Parts A and B medical expenses.

Program participants include Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield Northern Plans Alliance, CVS Health, Humana Insurance Company, UnitedHealthcare, and Wellcare Prescription Insurance Co. These six sponsors are testing models in 22 plan benefit packages. Together, they span across eleven states and 1.7 million beneficiaries.

In the model’s first year, the sponsors spent about $325 million less than the benchmark.

Exactly 50 percent of plans were eligible for the payment due to a two percent reduction in medical spending.

Of the remaining 11 plans, seven of them diminished their medical spending but not enough to hit the two percent mark. The remaining four plans saw an increase in spending.

The second year’s results were expected to be released in the first half of 2019. However, to date, they have not yet been published.

Until the results are officially released, however, Humana’s study provides hopeful insight into what their models in Arizona, Florida, Louisiana, Virginia, and the Great Plains Region are finding.

“This study’s findings provide support for optimizing medication therapy by focusing on resolution of medication-related problems through TMRs or CMRs in conjunction with TMRs,” Humana stated. “Humana’s Enhanced MTM (eMTM) strategy, a CMS Innovation Center Program where customized and targeted interventions will replace CMRs as a service type for the 2020 plan year, provides opportunities to continue to advance patient-centric clinical pharmacy services, as opposed to pursuing a one-size-fits-all CMR strategy.”