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Since the start of Medicare Part D in 2006, drug plan sponsors have been required to offer medication therapy management (MTM) programs to members who take what the rules describe simply as “multiple” drugs for “multiple” chronic conditions and whose Part D drug costs are expected to exceed $4,000 annually. But starting in 2010 — with products that need to be designed very soon — Part D sponsors must: lower the qualifying drug-cost threshold from $4,000 to $3,000; target beneficiaries at least quarterly; offer a minimum level of MTM services, including interventions for both beneficiaries and providers; and measure and report details of the number of comprehensive and targeted medication reviews, provider interventions and changes in therapy directly resulting from the interventions. Meanwhile, health plans and PBMs continue to grapple with how to handle members who take multiple medications, rack up enormous bills, and often suffer adverse outcomes due to a lack of effective medication management. Key questions: How will CMS’s rules alter your existing MTM program? To what extent will the changes improve members’ health and your plan’s bottom line? Two leading experts on MTM provide strategic insights and practical solutions on these and other important questions, including:
TIM SAWYERS is director of clinical pharmacy services at Medicare health plan operator HealthSpring, Inc. Mr. Sawyers has more than 30 years of management experience focusing primarily on managed markets, including managed care and pharmacy benefit management. In his current position at HealthSpring, Mr. Sawyers develops clinical programs and business strategies and negotiates contracts for brand and specialty pharmaceuticals. He also provides expertise in benefit design, management of drug formularies, physician and network communications, MTM programs and pharmacy policy. He is a member of various pharmacy organizations, including the Academy of Managed Care Pharmacy (AMCP), where he has served in leadership positions. He currently serves on AMCP’s Organizational Affairs Committee as vice chairman. Mr. Sawyers earned his pharmacy degree and MBA from the University of Cincinnati. DENISE KEHOE is vice president of business development at MTM provider PharmMD, where she brings more than 15 years of clinical pharmacy, research and operations experience. Ms. Kehoe recently served as national strategic executive of managed care sales and contracting for Walgreen Co., after holding positions with the company as regional vice president, regional clinical manager, shared faculty practitioner, pharmacist clinician, and multi-site pharmacy manager. Ms. Kehoe is active in the leadership of several trade organizations, including the American Pharmacists Association (APhA), where she is serving a two-year term as executive committee member-at-large for the APhA Academy of Pharmacy Practice Management, and AMCP, where she is serving on the group’s Community Pharmacy Outreach Task Force. She also is author of the “Medication Therapy Management” chapter in the Managed Care Pharmacy Practice book, released in December 2008 by Jones and Bartlett Publishers.
Executives, government affairs and compliance directors, business development and marketing directors, financial managers, pharmacy directors, medical officers, clinical services directors, consultants and contracting executives at:
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Listeners will also receive practical written information to supplement information covered by the audioconference speakers.
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