Survey of medication therapy management programs under Medicare part D

To describe and summarize the enrollment criteria and benefit designs for medication therapy management (MTM) programs offered throughout the United States during the first year of the Medicare Part D benefit.

Cross-sectional survey.

United States between November 1, 2005, and June 30, 2006.

MTM benefit plan managers of major health insurance companies nationwide selected nonrandomly by the investigators from lists provided by the Centers for Medicare & Medicaid Services.

Telephone interview and/or e-mail 12-item survey with mostly open-ended questions.

Characteristics required for a patient to be enrolled in MTM programs and types of services provided along with modes of delivery.

Interviews were completed or surveys returned from 21 distinct MTM programs representing 70 health insurance plans covering 12.1 million Medicare enrollees. Of the MTM programs offered, 90.5% restricted their enrollment based on number of diseases, with a median of 3 (range, 2-5) diseases required; 57.1% restricted enrollment based on the type of chronic condition; and 95.2% had requirements for the number of medications (median, 6; range, 2-24) necessary for enrollment in the program. The most frequently provided MTM services were patient education (75.0% of programs),patient adherence (70.0%), and medication review (60.0%). The median number of different service types provided by MTM programs was 3 (range, 2-7). MTM program services included the use of mailed interventions (76.1%) and inhouse call centers (90.4%). While only 4 of the 21 MTM programscontracted with pharmacies to provide some or all of their MTM services, these plans covered a large number of beneficiaries (7.5 million lives).

MTM programs offered by prescription drug plans and Medicare Advantage plans were highly variable during the first year of the Medicare Part D benefit. Definitive evidence supporting the effectiveness of many of the most common interventions is lacking.