Providers caring for Medicare patients with multiple cardiovascular conditions, including cardiologists, should explain to eligible patients about medication therapy management (MTM) programs, according to a recent study published in American Health & Drug Benefits. MTM programs, which are mandated under the 2003 Medicare Modernization Act for Part D prescription drug plans and Medicare Advantage plans, have been shown to improve medication adherence and reduce medication errors while reducing overall costs in patients with cardiovascular disease. However, the study authors note that while patients are often notified by health plans about their eligibility for MTM programs, providers do not typically know.

The study, which looked at patient data from 462 academic and private cardiology practices in the United States participating in the ACC’s PINNACLE Registry between May 1, 2008, and Sept. 30, 2010, found nearly a quarter of Medicare beneficiaries identified in the registry to be eligible for MTM.

Specifically, of the 93,089 Medicare beneficiaries identified in the Registry, 21.4 percent were eligible for MTM, based on the 2010 minimum eligibility criterion of an annual insurer medication expenditure of $3,000 or more. These costs ranged from $366 for low-cost generics to $3,958 for the highest-cost drug in a class. In addition, the proportion of patients eligible for MTM ranged from 7.9 percent for those eligible for MTM for low-cost generics to 64 percent of patients eligible for MTM for the highest-cost medication in a class.

"Payers indicate that the most common barrier to implementing MTM programs is the lack of interest and willingness of patients to participate in such programs," the authors said. "By taking a few minutes to ask patients with multiple CV conditions who are seeing a cardiologist whether they have been contacted by their insurer to participate in an MTM program and by encouraging patients to participate, providers are in a position to explain and to encourage patients to take advantage of such programs."

According to lead author Sarah Spinler, PharmD, Philadelphia College of Pharmacy, University of the Sciences, cardiologists who fail to urge patients to ask for and use MTM are missing a prime opportunity to involve patients in their own care and to facilitate a valuable intervention to improve patient outcomes.

In a related editorial comment, Albert Tzeel, MD, North Florida Humana, Jacksonville, FL, noted there is "significant room for improvement" in addressing patients who are eligible for MTM. "When it comes to improving the outcomes of care for [patients] with cardiovascular disease, all providers have a responsibility to share in the accountability for improved outcomes through patient-centered care," he writes.

Keywords: Insurance Carriers, Insurance Benefits, Drug Costs, Patient-Centered Care, Medication Adherence, Eligibility Determination, Medication Errors, Registries, Cardiology, Medication Therapy Management, Health Expenditures, Cardiovascular Diseases, Medicare