Examining the Medicare Part D Medication Therapy Management Program in the Context of Mental Health

Examining the Medicare Part D Medication Therapy Management Program in the Context of Mental Health
Kyle Walburg, PharmD, North Memorial Camden Clinic

Background: Mental health conditions can often lead to increased medical complexity due to increasing comorbid conditions, higher medication burden, increased utilization of the healthcare system, and fragmented care. Given the medical complexity, those with mental health conditions may benefit from use of medication therapy management (MTM) services. Mental health is one of the nine core chronic conditions outlined by the Center for Medicare and Medicaid Services (CMS) for eligibility for MTM services, however a study determining the utilization of these services with respect to those with mental health diagnoses has not been evaluated. Mental health conditions disproportionately affect Medicare beneficiaries compared with the general population; approximately 26% of Medicare beneficiaries carry mental health diagnoses.

Objective: To describe and compare the delivery of MTM services to Medicare beneficiaries with and without mental health conditions.

Study design: This cross-sectional study examined randomly sampled 2014 Medicare parts A, B, and D claims data, comparing this data to 2014 MTM data. Medicare data included participants that were continuously enrolled in Medicare part A, B, and D; data was evaluated for 825,003 beneficiaries that were MTM-enrolled. Patients with end-stage renal disease were excluded based on their complexity and potentially increased medication burden. 

Results: Beneficiaries were categorized into mental health cohorts (3,016,620 individuals, or 43%) and non-mental health cohorts (3,997,105 individuals, or 57%). The study found that there was a significantly higher MTM enrollment in the mental health cohort (17.4% vs. 7.5%, P<0.001). Once enrolled, a greater proportion of the non-mental health cohort received comprehensive medication review (19.3% vs. 17.7%, P<0.001). Those in the mental health cohort were more likely to have an emergency department visit or be hospitalized, and overall, used more medications than the non-mental health cohort (16 medications vs. 12 medications, P<0.001). Additionally, those in the mental health cohort were more likely to have a medication therapy problem (MTP) identified and resolved, when compared to the non-mental health cohort.

Of note, use of MTM was further reduced among beneficiaries in the mental health cohort that may have had lower socioeconomic status, were a part of racial and ethnic minority communities, were more medically complex, or classified as having schizophrenia and other psychotic disorders.

Conclusions: Despite beneficiaries from the mental health cohort being more likely to be enrolled in MTM, they were less likely to receive MTM services than the non-mental health counterpart. As the study identified more MTPs and a higher medication burden within this population, it is important to recognize a gap in care that could be better addressed by MTM delivery in the mental health population. Specifically, pharmacists could impact this disparity by considering outreach to patients who may benefit from this service, whether this be through unique care delivery models such as home visits or other considerations to close this gap.

Key point: A clear disparity exists between those with mental health diagnoses covered for MTM services through Medicare and those who receive the services. Pharmacists can help recognize this gap and work to better serve this patient population and resolve unmet medication-related needs.

Reference:

  1. Murugappan MN, Seifert RD, Farley JF. Examining Medicare Part D Medication Therapy Management program in the context of mental health. J Am Pharm Assoc (2003). 2020 Jan 15. pii: S1544-3191(19)30595-3. doi: 10.1016/j.japh.2019.12.008.