The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Medication Therapy Management (MTM)”

The Medicare MTM Program – Part II: Just What the Doctor Ordered

MTM: Just what the doctor orderedAs I mentioned in my last post, I’ve been writing a letter that invites my company’s Part D plan members to participate in Medicare’s Medication Therapy Management (MTM) program. The main feature of the Medicare MTM program is an annual comprehensive medication review, which includes a review of all medications, vitamins, and supplements with a pharmacist; a written summary and medication action plan to share with doctors; and a personal medication list. 

The letter has been written and approved, but I still have my doubts that it is going to convince people to take advantage of this free program. For some reason—well, many reasons—seniors who take a lot of medications just don’t think they need an annual medication review, even if their health and safety is at risk.

Aging and multiple medications increase your health risks

But here’s the hard truth, plain and simple: If you take multiple medications, your chances of ending up in the hospital because of dangerous side effects or a harmful drug interaction are pretty high. To make matters worse, aging increases your risk for medication side effects.

If you take multiple medications, you’re not alone

The average older American uses 4-5 prescription drugs and 2 over-the-counter medications.  The average nursing home resident uses at least 7-8 prescription drugs.  Here are a few other facts to consider:

• The more medications you take, the more chance there is for those drugs to interact negatively with each other — or with vitamins, supplements, and even certain foods.
• You may think the symptoms of such harmful interactions are normal, such as an upset stomach or feeling tired. Or you may not notice any symptoms at all. 
• If you are taking multiple drugs, there also is a greater risk of forgetting to take medications, taking them at the wrong time, or taking too much or too little.
• The more drugs you take, the more likely at least one of those drugs is not necessary.  

The MTM comprehensive medication review is just what the doctor ordered

Let’s face it. It’s not always easy to keep track of your drugs or know how to use them safely. That’s why the Institute of Medicine encourages people to participate actively in the healthcare process to prevent medication-related problems. One of the things that doctors suggest is a medication review with a healthcare provider at least once a year.

So what are you waiting for?

I hope I have encouraged at least a few seniors to participate in their Medicare prescription drug plan’s MTM program. And I hope you say “yes” if your plan invites you to have a comprehensive medication review with a pharmacist. Your health and safety depend on it.

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The Medicare MTM Program —Part I: Providers Say Yes, but Seniors Say No Thanks

Seniors say no to Medicare medication therapy managment

Most Medicare beneficiaries reject the free services provided by MTM programs.

Like all Medicare prescription drug plans, the Part D plan that I write for offers a special health benefit called a Medication Therapy Management (MTM) program. MTM programs are designed to help Medicare beneficiaries ensure their medications are working safely and effectively for the best possible clinical outcomes.

My assignment this week was to write a letter to all our plan members who are eligible for MTM this year. Not just any letter, but a compelling letter that encourages seniors to say “yes” to a free service that even many doctors recommend for patients who are taking multiple medications.

Easier said than done.

The MTM comprehensive medication review

The standard Medicare MTM program includes an annual comprehensive medication review for the beneficiary, which includes a review of all medications, vitamins, and supplements with a pharmacist; a written summary of the consultation and medication action plan to share with doctors; and a personal medication list.  All Medicare Part D sponsors are required to provide this service at no extra charge for members meeting the following MTM eligibility criteria:
• Have multiple chronic diseases
• Are taking multiple Part D covered drugs
• Are likely to spend more than a specific amount on Part D drugs during the year ($3,100 in 2012)

Although the people who concocted the Medicare Modernization Act of 2003 probably had good intentions when they set the guidelines for the MTM program, it appears that few seniors are actually taking advantage of the services the program provides.

Part of the reason why MTM participation is low is because the Centers for Medicare & Medicaid Services (CMS) places all the burden on the Part D sponsor: Plans must offer MTM services to all eligible beneficiaries each year, but participation is optional and must be sought out through letters or phone calls. Hence, my assignment to write a letter that makes members want to accept the free offer.

Low participation could also be due to neutral or even negative perceptions of the MTM program, and in particular, of comprehensive medication reviews (CMRs).  In a 2011 focus group study conducted by the University of Iowa College of Pharmacy, the majority of participants said they were not interested in the CMR, even though they are taking multiple medications and have a high medication risk rating.

Here are some responses they gave when asked why they did not want a CMR:
• Although I have multiple doctors and multiple medications, I consider myself at a low risk for a medication-related problem.
• The counseling I receive from my pharmacist is adequate so I don’t need a comprehensive review.
• This would be a waste of time for me because my pharmacist already talks to me whenever I have a new medication.
• My doctor should do this; not my pharmacist.
• I wasn’t aware that my Part D program offered this.

My recommendation to CMS: If you really want to help Medicare beneficiaries ensure all their medications are working together safely and effectively, don’t put the onus on Part D sponsors. Make the MTM program truly mandatory: Everyone who is eligible for the program must show proof of active participation in order to receive the prescription drug benefit. If that’s not possible — and it probably is not — than at least help sponsors out with outreach on your own CMS letterhead. Maybe a letter or phone call from CMS will work better — it’s worth a try.

Then maybe I won’t have to write a compelling letter that gets, at best, 5% of our eligible members to participate in MTM.

In Part II next week, I’ll talk about why CMRs are just what the doctor ordered.

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