Audio CD and written materials of AIS's audioconference on August 17, 2006

Medication Therapy Management Programs: How Plans Are Working Through the Confusion

Confusion reigns regarding the medication therapy management programs (MTMPs) that all Part D plan sponsors were required to have beginning in 2006. CMS has left many critical details of MTMPs undefined and is waiting to see how plans interpret the rules. But a flurry of bills recently introduced in Congress call for some standardization of MTMPs. Proponents of the current rules contend the market should determine MTMP standards, and it's unclear which position will prevail. So with plan sponsors left to fend for themselves, how should they determine eligibility? How can payers define and quantify return on investment? How can MTMPs be expanded to commercial settings as well?

Sponsored by Atlantic Information Services, Inc., publisher of Drug Benefit News, Medicare Part D Compliance News and Specialty Pharmacy News.

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Under the 2003 Medicare reform law, CMS requires all Part D plan sponsors to establish medication therapy management programs (MTMPs). Designed to ensure that drugs prescribed are "appropriately used to optimize therapeutic outcomes through improved medication use," MTMPs are only for particular beneficiaries: those with multiple chronic diseases, those who have filled multiple Part D-covered prescriptions and those likely to incur 2006 annual costs of at least $4,000 for Part D-covered drugs.

While CMS has offered some guidance, it also left a lot of unanswered questions for health plans to resolve. With 2007 MTMP data already submitted to CMS, health plans are gearing up for 2008. But how are payers interpreting the CMS rules? What have payers learned so far? What might change for 2008? And how can these MTMPs be used in commercial health plans to improve outcomes?

Get all the details from two industry leaders who have been working extensively with MTMPs. You'll learn about:

Speakers

WILLIAM J. SULLIVAN is the principal consultant and founder of Specialty Pharmacy Solutions, LLC in Orlando, Fla. For more than 25 years, Mr. Sullivan has held executive positions in health care and pharmacy risk management, particularly for patients with chronic illness. As a recognized leader in the specialty pharmacy (SRx) marketplace, Mr. Sullivan provides practical solutions for controlling high-cost injectables, infusibles and emerging biotech products. In 2002, he founded Specialty Pharmacy Solutions to provide expert consultative support to clients in the specialty pharmacy niche. Examples of major engagements include the development of multiple therapy-specific treatment management programs, the build-out of national sales and contracting programs for a publicly traded specialty pharmacy, RFP development/SRx vendor selection and contracting /program implementation for major health plans, due diligence on SRx acquisitions, competitive intelligence for pharmaceutical companies, etc. Mr. Sullivan's pharmacy, sales, business development and operations expertise helps his clients to develop sound strategies that contain costs and profitably expand their markets. He is an active member of the Academy of Managed Care Pharmacy (AMCP) and received his MBA in healthcare administration from Boston University.

ERIC J. CULLEY, Pharm.D., is the manager of clinical pharmacy services at Highmark Blue Shield, a Pittsburgh-based insurer with more than 2.3 million members with pharmacy benefits. Dr. Culley is currently responsible for Highmark's Pharmacy and Therapeutics Committee, as well as Highmark's formulary for commercial business and Medicare Part D. He is also responsible for coordinating drug utilization review programs, prior-authorization protocols, and the cost-savings analysis of those programs. Dr. Culley oversees Highmark's Medication Therapy Management program for Medicare Part D. He is actively involved in education of providers through publications, generic prescribing, and other quality initiatives. His team also provides clinical support for the company's sales and marketing division, member services, and the provider community. Dr. Culley has given presentations regarding the prescription drug management programs and their outcomes at both local and international conferences. He has published in managed care and other pharmacy journals, as well as professional and consumer reference textbooks. Dr. Culley is a guest lecturer at Duquesne University and the University of Pittsburgh schools of pharmacy, and he is currently a peer-reviewer for the Journal of Managed Care Pharmacy and Formulary.

Moderator: Angela Maas, managing editor of AIS's Specialty Pharmacy News and editor of AIS's Drug Benefit News.

 

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