CMS is considering new regulations that would require Medicare Part D prescription drug plans to contract directly with long-term-care facilities rather than with consultant pharmacists. This doesn't sit well with the American Society of Consultant Pharmacists.
The Centers for Medicare & Medicaid Services (CMS) is considering new regulations that would require Medicare Part D prescription drug plans (PDPs) to contract directly with long-term-care facilities (LTCs) rather than with consultant pharmacists.
Under these regulations, LTC facilities would provide beneficiaries with medication therapy management (MTM) beyond the already mandated monthly medication regimen review (MRR).
This doesn't sit well with the American Society of Consultant Pharmacists (ASCP). ASCP recommends a direct contract between Part D sponsors and consultant pharmacists.
"Contracting between PDPs and LTC facilities is a burdensome arrangement, both expensive and time-consuming, for the 2 parties, as well as for us," said Lynne Batshon, director, policy and advocacy for ASCP.
"PDPs will have to start from scratch and build their own LTC networks, since residents may be covered under different plans," she said. "If consultant pharmacists conduct both the review and MTM, it will reduce the cost of the pharmaceutical drug benefit through more efficient management."
She added, "Consultant pharmacists can offer a clinical perspective on complicated drug regimens for residents with co-morbidities and manage potential problems at point-of-sale. Beneficiaries need more attention than just dispensing a drug."
Batshon acknowledged that the CMS proposal is a step in the right direction of promoting MTM. However, she finds troubling CMS's lack of criteria for identifying beneficiaries who could benefit from services beyond the monthly review as well as the absence of a set of standards to distinguish between MRR and MTM. ASCP believes that without standards, LTC patients may not be able to take full advantage of MTM granted by the Medicare Modernization Act of 2003.
Consultant pharmacists play a critical role in achieving positive outcomes with MTM because they have access to complete medical records and are familiar with the facility and its residents and prescribers, Batshon said.