Medicare Part D

MO-PCN’s goal is to support all network pharmacists’ Part D patient care delivery opportunities by way of implementing education and training programs, working with plan sponsors and MTM vendors to increase their programs’ patient care  performance, as well as facilitate contracting if appropriate.

Medicare Part D (Part D) Comprehensive Medication Review (CMR)

What is Part D?

The Medicare Prescription Drug, Improvement, and Modernization Act (also called the Medicare Modernization Act or MMA) is a United States federal law, enacted in 2003.  It produced the largest overhaul of Medicare in the public health program’s 38-year history.  The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress.

What is a CMR?

MMA requires Part D prescription drug plans to include medication therapy management (MTM) services delivered by a qualified health care professional, including but not limited to pharmacists. MTM services target Medicare beneficiaries who have multiple chronic conditions, take multiple medications, and incur annual costs above a predetermined level. The total annual costs are recalculated annually. MTM offers a unique niche for the pharmacy profession, allowing pharmacists to apply their medication knowledge to support improved Medicare patient outcomes.

CMR is an interactive, person-to-person or telehealth medication review and consultation of a beneficiary’s medications (including prescriptions, over-the-counter (OTC) medications, herbal therapies, and dietary supplements) by a pharmacist or qualified provider that is intended to aid in assessing medication therapy and optimizing patient outcomes.

Who oversees Part D MTM programs?

The Centers for Medicare & Medicaid Services (CMS) must approve all Part D MTM programs.  A CMS approved MTM program is one of several required elements in the development of a Part D plan sponsor’s bid. Plan sponsors must submit an MTM program description to CMS for review and approval. Each year, they can change the targeted medications and chronic conditions. CMS evaluates each program description as part of a Part D quality improvement requirement, ensuring it meets the current minimum program year requirements.

Do all Part D plan sponsors offer pharmacist MTM program participation?

Part D plan sponsors have options for providing beneficiaries the required CMR.  For example, they may design a program that uses internal health care staff or, they may choose to contract out for their patient care delivery directly with health care providers or possibly through an MTM platform vendor, such as Mirixa or OutcomesMTM.

In order to deliver a CMR or other defined patient care programs, you must be contracted, either directly with the plan sponsor or through your member Pharmacy Services Administration Organization (PSAO) or corporate chain pharmacy.

Next Steps:

  1. Make sure you are contracted for available Part D plan sponsor program opportunities in your area, which support pharmacist-delivered patient care.
  2. Complete MTM vendor platform training, if applicable and needed.
  3. Complete available patient care cases.

Here are some helpful links to prominent MTM vendor platforms:

Medication Management Systems