A report prepared for the Democratic Governors Association suggests policy options for getting Medicaid beneficiaries to take their medicine that include managing medication, coordinating prescription refills, allowing more time between refills and generally teaching people why they should do what their doctor tells them. The recommendations primary apply to Medicaid, but they could also apply to state employee health plans and exchange insurance, the report states.
The paper states that it’s key to use medication therapy management only on those patients who need it. CMS recently scrapped a proposal to expand MTM in Medicare in part because plans complained that they would lose money if forced to contact enrollees who don’t need the service. The medication-adherence coalition Prescriptions for a Healthy America is now working on a legislative proposal aimed at better targeting people who need MTM.
That coalition- which includes pharmaceutical, chain drug store and pharmaceutical benefit manager members- also contributed to the paper prepared for the Democratic governors. That paper says “super user” programs could offer MTM to the approximately 5 percent of beneficiaries who are in those programs. It points out that an evaluation of 14 super-user programs found that teaching medication adherence is a key feature in all of those programs so it’s a natural step to go further with MTM. There also are 20 states with MTM programs that other states could look to, according to the paper.
Source: Inside Health Policy, 6/6/14