NCPA lobbies for MTM coverage under Medicare Part D

ALEXANDRIA, Va. — The National Community Pharmacists Association on Wednesday urged U.S. Senators on the Senate Finance Committee to support a proposal — scheduled for a vote as soon as Thursday — intended to expand coverage in the Medicare Part D prescription drug program of medication therapy management programs.

“Community pharmacists are highly trained medication experts and expanding the MTM services that they provide can achieve better health outcomes and lower overall costs,” Douglas Hoey, NCPA CEO said. “The challenges of not adhering to prescription drug therapy are real and expensive, and pharmacist-delivered MTM services can make a world of difference for patients.”

The change is proposed by Sens. Pat Roberts, R-Kan., and Robert Casey, D-Penn., as an amendment to legislation before the Senate committee that would temporarily prevent cuts to Medicare payments to physicians. The Roberts-Casey amendment would require the U.S. Centers for Medicare and Medicaid Services to study whether the coverage of MTM services for patients with one chronic condition would reduce Medicare spending overall through the avoidance of costlier treatments such as hospitalizations. If CMS determines that the expansion in coverage would lower costs, then the expansion of MTM coverage would be required. Currently, only those patients suffering from specific multiple chronic conditions are eligible for MTM services.

Research indicates that the cost savings from MTM can be significant. One Minnesota study found a 12-to-1 return-on-investment for MTM.  In North Carolina, MTM programs helping seniors produced a 13-to-1 return.  

MTM involves pharmacists working with patients to review and monitor their medication plan to maximize its effectiveness and avoid potential health problems, ultimately helping to reduce costs in the long run.  

The Roberts-Casey amendment stems from bipartisan legislation (S. 557, the Medication Therapy Management Empowerment Act) introduced by Sen. Kay Hagan, D-N.C., and cosponsored by Casey, Roberts and 28 other senators.

 

 

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