The CMS is launching an experiment to increase medication adherence for Medicare beneficiaries on Part D plans.
The initiative, known as the medication therapy management model, will offer insurance companies incentives to boost adherence. The initiative explicitly targets stand-alone Part D plans, versus Medicare Advantage Plans with Part D offerings.
The focused approach is critical, experts say.
“The rationale is that Medicare Advantage plans currently have more of an incentive than stand-alone Part D plans to work with patients to take their medications because they are on the hook for hospitalizations,” said Tricia Neuman, senior vice president of the Kaiser Family Foundation's program on Medicare policy.
“This new model is testing whether ... this leads to better patient care, fewer avoidable hospitalizations and emergency room visits, and Medicare savings,” she said.
Participating plans will be able to offer different medication therapy management services based on enrollees' level of medication-related risk, with interventions tailored to those enrollees' specific barriers to improvement.
Currently, Part D statutory and regulatory medication therapy management provisions require uniform service offerings to enrollees who meet the plan's program criteria, based on numbers of medications and chronic conditions and expected annual prescription drug costs.
News of the new model comes as stand-alone Part D plan premiums are projected to increase, while the number of plans will decrease, according to a Avalere analysis released Monday.
The research firm found that the top 10 most popular Part D plans, representing more than 80% of Part D plan enrollment, will have an average premium increase of 8% in 2016. That means some beneficiaries will be paying more than $40 a month for the first time in the program's history. The number of plans is dropping 13.5%, from 1,001 currently to 886 next year.
“Medicare beneficiaries should carefully review their prescription drug plan options in 2016 to make sure they choose a plan that is right for them,” Colin Shannon, senior manager at Avalere Health, said in a statement. “With many plans taking large premium increases in 2016, those beneficiaries that choose not to change plans will likely pay more in premiums than if they look for lower cost options.”
CMS officials say those changes are for good reasons.
“As part of our approach to building a healthcare delivery system that results in better care, smarter, spending and healthier people, CMS will test changes to the Part D program to give prescription drug plans stronger incentives and flexibility to improve prescription drug safety and efficacy,” Dr. Patrick Conway, the CMS' deputy administrator for innovation and quality, said in a statement about the model.
Medication adherence for Part D beneficiaries has been consistently eroding as drug prices have surged, recent research has shown.
For instance, non-adherence increased from 14.4% in 2009 to 17% in 2011 among elderly beneficiaries with four or more chronic conditions a 2014 Health Affairs analysis found. Similarly, the prevalence among the sickest elderly of forgoing basic needs to purchase medicines went from 6.8% in 2009 to 10.2% in 2011.
The five-year pilot will take place in five regions: Arizona, Florida, Louisiana and Virginia, and a larger region that includes Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming.
Plans in those regions will have to seek CMS approval to participate in the model.
