Private Medicare Drug Plans provide insufficient  ...“Medication Therapy Management,” putting older and disabled Americans at risk for hospitalization and institutionalization…National consumer group calls on CMS to establish and enforce meaningful MTM standards    

New York, NY – Most private Medicare drug plans do not provide adequate medication therapy management (MTM) for eligible members, despite a provision in the Medicare Modernization Act requiring private insurers participating in the government program to provide this critical service at no cost, according to a brief by the Medicare Rights Center.

MTM was intended by law “to optimize therapeutic outcomes through improved medication use and to reduce the risk of adverse events” for private Medicare drug plan members who have multiple chronic diseases, are taking multiple medications, or are likely to incur high annual drug costs (at least $4,000 in 2006).

“If Centers for Medicare and Medicaid Services considers medication therapy management to be the ‘cornerstone’ of the Medicare drug benefit as it says, then it should regulate private plans and not bow to them,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service organization.  

“Until CMS raises the bar and requires profiteering drug plans to utilize the best medication therapy management practices available today, people will suffer needlessly and have costly hospital and nursing homes stays.”

CMS has given the private insurers significant discretion in the design of the MTM plans, the consumer group reports.   The majority of popular plans are only providing educational material by mail or over the phone with in-house staff rather than face-to-face interaction with an independent pharmacist or care team.  Few plans provide comprehensive medical review or follow-up.   

 The United States spends $200 billion every year to correct medication-related problems.  Older adults have an increased incidence of chronic illness, take more mediations on average and often have more trouble managing their medications as they age, making them more vulnerable to medication-related problems.

As many as 55 percent of older adults fail to comply with their medication regime, particularly people with Alzheimer’s disease or other dementias.  Nearly 28 percent of hospital admissions for people age 65 or older are due to mediation-related problems, which are estimated to be one of the five top causes of death for this age group.  Nearly one quarter of all hospital admissions result from people being unable to take their medications properly.       

In Making Medicare Therapy Management a Cornerstone of Community-Based Care for People with Alzheimer's Disease and Other Forms of Dementia, the Medicare Rights Center recommends that Congress move toward providing MTM under Medicare Part B, to ensure that the private plans’ economic incentives do not impinge on the quality of their MTM programs.  Until then, the consumer group recommends that CMS require the plans to deliver the robust MTM services that are available today and take an active role in promoting pilot projects that would allow “best practices” to emerge.