The Part D Enhanced Medication Therapy Management (MTM) model tests whether providing Part D sponsors with additional payment incentives and regulatory flexibilities promotes enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. The model is an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen health care system linkages.
There are six Part D sponsors participating in the Part D Enhanced Medication Therapy Management Model.
- Blue Cross and Blue Shield Northern Plains Alliance
- Blue Cross and Blue Shield of Florida
- CVS Health
- WellCare Prescription Insurance
The Part D Enhanced Medication Therapy Management (Enhanced MTM) model represents an opportunity for stand-alone basic Prescription Drug Plans (PDPs) in selected regions to offer innovative MTM programs, aimed at improving the quality of care while also reducing costs. As part of the “better care, smarter spending, healthier people” approach to improving health delivery, CMS and accepted participants are testing changes to the Part D program that would achieve better alignment of PDP sponsor and government financial interests, while also creating incentives for robust investment and developing innovative MTM targeting and interventions. The objectives for this model are for stand-alone basic PDP sponsors to learn how to “right-size” their investment in MTM services and identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen health care system linkages.
The Enhanced MTM has a five-year performance period that began January 1, 2017. CMS is testing the model in 5 Part D regions: Region 7 (Virginia), Region 11 (Florida), Region 21 (Louisiana), Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming), and Region 28 (Arizona). Participating basic stand-alone PDPs in these regions, upon approval from CMS, can vary the intensity and types of MTM items and services based on beneficiary risk level and seek out a range of strategies to individualize beneficiary and prescriber outreach and engagement. Participants can accomplish these goals by leveraging the core competencies of their own organizations, and of their network pharmacy providers, with those of medical prescribers to accurately identify and effectively intervene with all beneficiaries whose issues with medication management have caused, or are likely to cause, adverse outcomes and/or significant non-drug program utilization and costs. Participants for the model were chosen in August 2016 and the model is not currently accepting new applicants.
Questions regarding the Part D Enhanced MTM model may be directed to EnhancedMTM@cms.hhs.gov.
Latest Evaluation Report
- Two Pager: At-A-Glance Report (PDF)
- Announcement (PDF)
- Fact Sheet
- Fact Sheet - First Year Results (PDF)
- Fact Sheet - Second Year Results (PDF)
- Press Release
- Request for Applications (PDF)
- Enhanced MTM Evidence Base (PDF)
- Prescriber Technical Expertise Panel (PDF)
- Response to Stakeholder Inquiries (PDF)
Model Participant Resources
- Enhanced MTM Encounter Specification Plan (PDF)
- Enhanced MTM Encounter Specification Appendix (XLS)
- Enhanced MTM Encounter Specification Plan Public Comment Summary (PDF)
Model Learning Events
- Webinar: Introduction (Oct. 21, 2015)
- Webinar: State of the Art for Standards and Interoperable for Data Exchange (Nov. 18, 2015)
- Webinar: Enhanced Medication Therapy Management: Innovations in HIT-enabled MTM-related care (Dec. 15, 2015)