SummaryAvalere recently partnered with Third Way to estimate the cost savings of increasing medication adherence among Medicare beneficiaries by improving and expanding the current Part D Medication Therapy Management (MTM) program to target and address adherence issues for specific conditions.
The report recommends that policymakers improve and advance drug therapy support by implementing six key strategies.
- Require the Centers for Medicare & Medicaid Services (CMS) to establish high-priority criteria for adherence improvement efforts.
- Designate the responsibility of monitoring patients’ medication adherence to specific providers.
- Improve CMS’ medication therapy management program with better criteria and more flexibility for targeting services.
- Issue performance-based payments to providers that deliver drug therapy support services.
- Expand the role of pharmacists through payment policy and prescribing agreements with physicians.
- Continue to improve and expand the use of adherence quality measures to encourage more effective drug therapy support programs.
Avalere estimates that the proposal would reduce federal spending on the Medicare program by $4.7 billion over the 10-year federal budget window from 2015 to 2024. Third Way anticipates the spill-over effects to Medicaid and the commercial insurance market would result in an additional $2.7 billion in savings. The estimates account for the increased spending on medication and performance-based payments to providers, offset by a reduction in healthcare events that studies have shown can be avoided with greater medication adherence.
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