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Alexandria, Va. – The Pharmacy Quality Alliance (PQA) has issued an eight-point call to action for improving the quality and measurement of medication therapy management (MTM) services. The call was developed with extensive stakeholder input as part of a national, multi-phase initiative that PQA launched in 2023 to identify a pathway for new quality measures. It is the focus of a report published today, “Advancing Medication Therapy Management Quality Measurement.”
“PQA, our members and the health care community have been exploring opportunities to develop MTM quality measures focused on service quality and clinical endpoints for years,” PQA CEO Micah Cost, PharmD, MS, CAE, said. “Challenges persist related to data and practice variation, complicating the path to new measures. Our call to action outlines a series of interrelated and necessary areas where additional work is needed to advance MTM-related quality improvement and measurement.”
The Centers for Medicare & Medicaid Services (CMS) requires Medicare Part D plan sponsors to establish an MTM program to ensure covered Part D drugs are appropriately used to optimize therapeutic outcomes and to reduce the risk of adverse events. PQA developed and stewards the health plan performance measure used in the Part D Star Ratings to evaluate MTM quality, which focuses on the MTM program completion rate for comprehensive medication review.
“CMS has made significant changes to the MTM program requirements over the years to enhance enrollment, improve the quality of services and reduce gaps in care,” PQA Chief Quality and Innovation Officer Lisa Hines, PharmD, CPHQ, said. “In April, CMS finalized changes that will take effect next year and expand the eligibility criteria for the Part D MTM program. These significant changes to the MTM program and our call to action are an opportunity to advance the quality and measurement of MTM services.”
The call to action’s eight elements are:
· Investigate optimal MTM eligibility and targeting criteria for achieving program goals.
· Enhance collaboration between prescribers, MTM providers, and plan sponsors to better address patient goals of care and implement appropriate medication changes.
· Optimize patient and prescriber awareness of Part D MTM services and the benefits patients may receive.
· Amplify the patient voice to improve the patient-centeredness of MTM programs.
· Strengthen requirements for the use of standardized health information technology for documentation of MTM services.
· Increase consistent use of the PQA Medication Therapy Problem Categories Framework through stakeholder education.
· Develop new performance measures for MTM quality.
· Prioritize research to optimize the Part D MTM program and services.
The elements are not in priority order and require partnerships and coordinated efforts from a multitude of stakeholders across the industry. Their development was informed by an environmental scan, an in-person convening event, public comment period and follow-up webinar.
This MTM initiative is led by the PQA Quality Innovation and Research Center (QuIRC), a strategic initiative to accelerate progress in medication use quality and focus on clinical outcomes and provider contributions to care. The first phase of this initiative was funded in part by Novo Nordisk and Outcomes. PQA general funds, which include dues from PQA’s diverse, multi-stakeholder membership, also supported this work.
