Study: Enhanced Health Benefits from a Tailored Medication Management Approach for Medicare Advantage Part D Participants

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Key findings from a Humana Inc. (NYSE: HUM) study published in the June 2019 issue of Journal of Managed Care & Specialty Pharmacy (JMCP), highlight the differences in effectiveness between medication therapy management (MTM) services and the untapped potential for certain interventions.

MTM refers to a range of services provided by a health care professional, usually a pharmacist, to help patients get the most benefit from their medications and to identify and prevent medication-related problems. An MTM program is required for Medicare Part D plans; these services are offered through Humana’s RxMentor program for individuals with Humana Part D plans.

Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are two medication therapy management interventions defined by the Centers for Medicare and Medicaid Services (CMS). CMRs, which are required by CMS to be offered annually to every eligible patient, involve an interactive review of all medications taken by a patient. Patients then receive a cover letter, a personal medication list, and a medication action plan specific to the patient’s drug regimen.

TMRs represent ongoing medication monitoring to assess medication use and identify specific actual or potential medication-related problems such as high-risk medications, drug-drug interactions, or medication non-adherence. Identified problems are then addressed by the reviewer with the patient or prescriber.

The two years of MTM data analyzed in this study revealed that TMR interventions were associated with statistically significant reductions in acute inpatient admissions and increases in medication adherence. CMR interventions were only associated with reductions in acute inpatient admissions when the patient had a known medication-related problem. In the most recent year of analysis, there were significant reductions in emergency department (ED) visits for participants receiving TMR-only interventions or CMR interventions in conjunction with TMRs. In other words, receiving medication therapy management services targeted at resolving medication-related problems indicated an existing unmet need, and thus these were the patients who were more likely to benefit from MTM services.

Medicare Part D plans have some discretion in determining program criteria, such as the number of medications or types of conditions that will qualify a patient to receive medication therapy management services. The CMS stars rating system for recognizing the quality of Part D plans currently includes a metric for the proportion of eligible members who complete a CMR. This incentivizes Part D plans to focus on CMR completion and may limit investments in TMR activities.

Michael Taday, Associate Vice President of Pharmacy Clinical Strategies and Operations for Humana Pharmacy Solutions, explains, “This study highlights how critically important it is for Part D and Medicare Advantage plans to continue to innovate in their efforts to contribute to better therapeutic outcomes for the patients they serve.”

Optimal medication utilization is important for good clinical outcomes and best use of resources. This study’s findings provide support for optimizing medication therapy by focusing on resolution of medication-related problems through TMRs or CMRs in conjunction with TMRs. Humana’s Enhanced MTM (eMTM) strategy, a CMS Innovation Center Program where customized and targeted interventions will replace CMRs as a service type for the 2020 plan year, provides opportunities to continue to advance patient-centric clinical pharmacy services, as opposed to pursuing a one-size-fits-all CMR strategy.

Scott Greenwell, President of Humana Pharmacy Solutions, comments, “We are excited that this study reveals an opportunity for our pharmacists to educate and empower patients and coordinate care with clinicians to improve health outcomes.”

The paper was authored by Humana employees Erin Ferries, PhD, MPH, Benjamin Hall, PhD, FSA, MAAA, Lilian Ndehi, PharmD, MBA, Phil Schwab, PhD, and Jamieson Vaccaro, MA, and by former Humana employee Joseph T, Dye, PhD, RPh.


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