Few Medicare beneficiaries enroll in drug-management program

Fewer than half of Medicare beneficiaries eligible for a program designed to review medication usage among those with high drug-utilization rates were enrolled in 2012, according to a CMS data analysis from Avalere Health.

Just 11% of Medicare Part D beneficiaries were enrolled in a medication-therapy management program, which all participating plans are required to offer, the Washington-based consulting and research firm found.

“There absolutely should be cost savings associated with medication-therapy management programs,” said Dan Mendelson, CEO of Avalere. “This is really a program that needs to be used more. The question is why is there this dramatic disparity between the people who CMS is willing to pay for the program and the people who are using it?”

That under-usage is occurring despite the fact that 25% of prescription-drug beneficiaries were eligible for the program. Individuals with at least two chronic conditions, and who take at least three medications and have annual prescriptions costs of more than $3,100, were eligible for the program in 2012.

Significant discrepancies exist among plans in terms of medication-therapy management enrollments, Avalere found. Among the 10 most popular Medicare plans, enrollment ranged from 4.6% to 17.5%.

Plans also are required to offer individuals eligible for the prescription-management program a comprehensive review of their medication regimen. But fewer than 10% of eligible Part D beneficiaries actually received such a review in 2012, according to the Avalere analysis.

However, individuals enrolled in Medicare Advantage plans that included prescription-drug coverage were almost three times as likely as those in stand-alone plans to receive a comprehensive review of their prescription plan.

“Medicare Advantage plans realize that better medication management can reduce medical costs and improve clinical outcomes,” said Matthew Eyles, executive vice president at Avalere Health, in a statement. “As a result, MA plans are much more active in reviewing beneficiary medications and making important changes, compared to standalone Medicare drug plans.”

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