Trends in medicare Part D medication therapy management eligibility criteria

Junling Wang, Ya Chen Tina Shih, Yolanda Qin, Theo Young, Zachary Thomas, Christina Spivey, David K. Solomon, Marie Chisholm-Burns

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized. OBJECTIVES: To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs. METHODS: This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008-2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans. RESULTS: For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases. CONCLUSION: The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans.

Original languageEnglish (US)
Pages (from-to)247-254
Number of pages8
JournalAmerican Health and Drug Benefits
Volume8
Issue number5
StatePublished - Jul 1 2015

Fingerprint

Medicare Part D
Medication Therapy Management
Chronic Disease
Medicare
Medication
Therapy
Enrollment
Medicaid
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Strategy and Management

Cite this

Trends in medicare Part D medication therapy management eligibility criteria. / Wang, Junling; Shih, Ya Chen Tina; Qin, Yolanda; Young, Theo; Thomas, Zachary; Spivey, Christina; Solomon, David K.; Chisholm-Burns, Marie.

In: American Health and Drug Benefits, Vol. 8, No. 5, 01.07.2015, p. 247-254.

Research output: Contribution to journalArticle

Wang, Junling ; Shih, Ya Chen Tina ; Qin, Yolanda ; Young, Theo ; Thomas, Zachary ; Spivey, Christina ; Solomon, David K. ; Chisholm-Burns, Marie. / Trends in medicare Part D medication therapy management eligibility criteria. In: American Health and Drug Benefits. 2015 ; Vol. 8, No. 5. pp. 247-254.
@article{b87bd4fd888e433585d4e549264f42fb,
title = "Trends in medicare Part D medication therapy management eligibility criteria",
abstract = "BACKGROUND: To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized. OBJECTIVES: To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs. METHODS: This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008-2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans. RESULTS: For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7{\%} of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20{\%} of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80{\%} restricting enrollment to patients with 3 or more chronic diseases. CONCLUSION: The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans.",
author = "Junling Wang and Shih, {Ya Chen Tina} and Yolanda Qin and Theo Young and Zachary Thomas and Christina Spivey and Solomon, {David K.} and Marie Chisholm-Burns",
year = "2015",
month = "7",
day = "1",
language = "English (US)",
volume = "8",
pages = "247--254",
journal = "American Health and Drug Benefits",
issn = "1942-2962",
publisher = "Engage Healthcare Communications, Inc.",
number = "5",

}

TY - JOUR

T1 - Trends in medicare Part D medication therapy management eligibility criteria

AU - Wang, Junling

AU - Shih, Ya Chen Tina

AU - Qin, Yolanda

AU - Young, Theo

AU - Thomas, Zachary

AU - Spivey, Christina

AU - Solomon, David K.

AU - Chisholm-Burns, Marie

PY - 2015/7/1

Y1 - 2015/7/1

N2 - BACKGROUND: To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized. OBJECTIVES: To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs. METHODS: This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008-2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans. RESULTS: For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases. CONCLUSION: The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans.

AB - BACKGROUND: To increase the enrollment rate of medication therapy management (MTM) programs in Medicare Part D plans, the US Centers for Medicare & Medicaid Services (CMS) lowered the allowable eligibility thresholds based on the number of chronic diseases and Part D drugs for Medicare Part D plans for 2010 and after. However, an increase in MTM enrollment rates has not been realized. OBJECTIVES: To describe trends in MTM eligibility thresholds used by Medicare Part D plans and to identify patterns that may hinder enrollment in MTM programs. METHODS: This study analyzed data extracted from the Medicare Part D MTM Programs Fact Sheets (2008-2014). The annual percentages of utilizing each threshold value of the number of chronic diseases and Part D drugs, as well as other aspects of MTM enrollment practices, were analyzed among Medicare MTM programs that were established by Medicare Part D plans. RESULTS: For 2010 and after, increased proportions of Medicare Part D plans set their eligibility thresholds at the maximum numbers allowable. For example, in 2008, 48.7% of Medicare Part D plans (N = 347:712) opened MTM enrollment to Medicare beneficiaries with only 2 chronic disease states (specific diseases varied between plans), whereas the other half restricted enrollment to patients with a minimum of 3 to 5 chronic disease states. After 2010, only approximately 20% of plans opened their MTM enrollment to patients with 2 chronic disease states, with the remaining 80% restricting enrollment to patients with 3 or more chronic diseases. CONCLUSION: The policy change by CMS for 2010 and after is associated with increased proportions of plans setting their MTM eligibility thresholds at the maximum numbers allowable. Changes to the eligibility thresholds by Medicare Part D plans might have acted as a barrier for increased MTM enrollment. Thus, CMS may need to identify alternative strategies to increase MTM enrollment in Medicare plans.

UR - http://www.scopus.com/inward/record.url?scp=84940640520&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940640520&partnerID=8YFLogxK

M3 - Article

VL - 8

SP - 247

EP - 254

JO - American Health and Drug Benefits

JF - American Health and Drug Benefits

SN - 1942-2962

IS - 5

ER -