Medication therapy management services under Medicare Part D: A pilot test to contract a provider

Background: Medication Therapy Management (MTM) services increase safety and reduce costs. The Medicare Modernization Act of 2003 mandated provision of MTM services by Prescription Drug Plans (PDPs) or Medicare Advantage Plans. The law was implemented in 2006, allowing pharmacists and other qualified professionals to provide MTM services to Medicare beneficiaries enrolled under Part D and obtain reimbursement. CMS stipulated that PDP plans offer MTM services to enrollees with multiple chronic diseases, multiple prescription drugs, and high drug costs (e.g. expected to reach the doughnut hole). Objective: to assess the Medicare Part D MTM process of service delivery, including contracting and reimbursement by PDPs. Methods: We attempted to enlist a local certified geriatric pharmacist as an MTM provider with 20 PDPs in Nevada, and requested contracts. Our plan was to qualitatively analyze the contracts and to follow the process as the pharmacist provided services. We also appraised all available MTM services in the state. Results: Attempts to obtain PDP contracts were unsuccessful. Most of the PDPs contacted were either unaware of the MTM program or reported they did not contract with outside consultants. At least four confirmed use of in-house professionals only. Four insurance companies sent out the wrong forms and did not respond to further inquiry. Discussion/Conclusion: Medicare PDPs do not readily provide contracts to geriatric pharmacists. This reveals limitations of the private contracting system in health services. During the study CMS issued more specific MTM program requirements for 2010. Increased awareness of all stakeholders will boost safety and efficiency.