Reprint of: Examining Medicare Part D Medication Therapy Management program in the context of mental health

Abstract

ObjectivesTo describe and compare the delivery of medication therapy management (MTM) between Medicare beneficiaries with and without mental health conditions. DesignNationally representative cross-sectional study that used a 20% random sample of 2014 Medicare Parts A, B, and D data merged with a 100% sample of 2014 MTM data. Setting and participantsMedicare beneficiaries continuously enrolled in Parts A, B, and D in 2014 were included in this study. Comprehensive medication review (CMR) use and MTM delivery were examined among a subset of 825,003 MTM-enrolled beneficiaries. Outcome measuresPredisposing, enabling, and need characteristics were selected on the basis of the Andersen Behavioral Model of Health Services Use. Descriptive, bivariable, and multivariable logistic regression statistics were used to determine associations between beneficiary characteristics and MTM delivery. ResultsA total of 3,016,620 (43%) and 3,997,105 beneficiaries (57%) were categorized into mental health and nonmental health cohorts, respectively. MTM enrollment in the mental health cohort was significantly higher than that in the nonmental health cohort (17.4% vs. 7.5%, P < 0.001). However, once enrolled, a greater proportion of beneficiaries in the nonmental health cohort received CMRs (19.3% vs. 17.7%, P < 0.001). Patients in the mental health cohort were more likely to have hospitalization (22% vs. 9.2%, P < 0.001) or emergency department visit (25.2% vs. 11.5%, P < 0.001) and used more medications in 2014 (16 % vs. 12%, P < 0.001). The proportion of patients in the mental health cohort receiving a CMR in 2014 that had at least 1 medication-related problem (MRP) identified and resolved was higher than that of patients in the nonmental health cohort (24.8% vs. 20.6%, P < 0.001). ConclusionAlthough patients with mental health conditions are more often enrolled into MTM, they are less likely to receive a CMR once enrolled. Given that this population has higher medical complexity and a higher MRP burden following a CMR, opportunities exist for pharmacists to enhance MTM delivery in this population.