Variability in state Medicaid medication management initiatives.

Abstract

Many U.S. states have expanded Medicaid programs, with over 70 million beneficiaries now enrolled. States' interest in improving care quality and lowering costs has spurred experimentation with several medication management (MM) programs. The implementation of MM programs for beneficiaries has been sporadic, and program elements and implementation methods have been heterogeneous. A survey was conducted to: (1) determine covered MM services in state Medicaid programs, (2) report innovative MM program findings, and (3) identify challenges in creating sustainable MM programs. The survey was sent to state Medicaid pharmacy directors in February 2015. The survey data focused on the type and extent of pharmacist-provided MM services, MM provider qualifications, patient eligibility criteria and enrollment strategies, MM delivery settings and referral patterns, MM program evaluations, program costs and sustainability models, key implementation challenges, and future program enhancements. Many Medicaid programs generally followed Medicare Part D Medication Therapy Management requirements. Highly variable findings were due to different Medicaid eligibility criteria, pharmacist integration with health teams, access to electronic medical records (EMRs), and MM delivery methods/settings to optimize drug therapy regimens. Several implementation challenges were identified. Pharmacist integration on care teams and access to EMRs improves MM implementation. MM program evaluation funding and data support must be secured prior to program implementation. The findings and discussion here can assist states with limited or preliminary Medicaid MM experience to progress toward sustainable programs.