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The latest CMS "innovation model" will test whether providing Medicare Part D prescription drug plan (PDP) sponsors with financial incentives and flexibility with regard to medication therapy management (MTM) program requirements can improve quality and reduce costs by "right-sizing" investment in MTM services. Specifically, CMS will allow stand-alone PDP sponsors in 11 states to apply for the Part D Enhanced MTM Model, which will provide:
- Additional regulatory flexibilities to allow for more individualized and risk-stratified MTM interventions that seek to optimize medication use by specific patients;
- A prospective payment for more extensive MTM interventions that will be "outside" of a plan's annual Part D bid; and
- A performance payment, in the form of an increased direct premium subsidy, for plans that successfully reduce fee-for-service expenditures and meet quality and other data reporting requirements.
CMS has scheduled an October 21, 2015 webinar to discuss the model; registration is required.
This article is presented for informational purposes only and is not intended to constitute legal advice.
