Summary of the Executive Sessions on Medication Therapy Management Programs

Abstract

Pharmacists and other health care professionals, as well as Medicare beneficiaries, had reason to welcome passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108–173). The act requires, among other things, that all prescription drug plan sponsors participating in Medicare Part D and Medicare Advantage plans providing a drug benefit under Part C offer a medication therapy management (MTM) program to help ensure that drugs are used to “optimize therapeutic outcomes through improved medication use, and to reduce the risk of adverse events, including adverse drug reactions,” in certain high-risk patients. The Medicare beneficiaries targeted by the MTM program are those who have multiple chronic conditions, are taking multiple medications, and are likely to incur high drug costs. The opportunity for the MTM program to influence the quality and cost of care purchased by Medicare is extraordinary. Just under 80% of Medicare beneficiaries have multiple chronic conditions, and 20% of Medicare beneficiaries have five or more chronic conditions, with the latter group accounting for over two thirds of Medicare spending.1 In general, health care spending for a person with one chronic condition is 2 times greater than spending for someone without any chronic conditions, while spending is about 14 times greater for someone with five or more chronic conditions. For these patients, the law provides access to a range of professional services designed to improve the safety and efficacy of drug therapy. For pharmacists, this presents a new and important opportunity to collaborate with patients and other health care professionals to improve medication-use outcomes. The federal government hopes that the act will not only bring about better patient outcomes but also moderate the rate at which health care and drug costs have increased in recent years.