GTMRx to CMS: MA needs to support team-based, interprofessional care that includes CMM

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Coalition submits comments to enhance Medicare Advantage

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GTMRx fully supports the [CMS] Vision for Medicare to advance health equity, expand access to affordable health coverage and care, drive high quality person-centered care, promote affordability and sustainability, and the intent to engage partners and communities.

Wednesday, the Get the Medications Right™ (GTMRx) Institute submitted comments urging the Centers for Medicare & Medicaid Services to support value-based payment models that incentivize team-based, interprofessional care that includes comprehensive medication management (CMM) services provided by clinical pharmacists working in collaboration with clinicians.

The GTMRx Institute is a non-profit coalition of 1,700 members focused on ensuring optimal use of medication and gene therapies through interprofessional and team-based care through a scientific, evidence-based and cost-effective decision-making process: CMM.

GTMRx responded to a CMS Request for Information regarding improvements to the Medicare program, specifically concerning the Medicare Advantage program.

“GTMRx fully supports the [CMS] Vision for Medicare to advance health equity, expand access to affordable health coverage and care, drive high quality person-centered care, promote affordability and sustainability, and the intent to engage partners and communities,” wrote Katherine H. Capps, co-founder and executive director of the GTMRx Institute. “We believe that CMM, implemented based on a standard, evidence-based process, should be a central component of CMS’ future program and innovation efforts.”

Citing robust evidence and well-documented use cases, GTMRx made the following recommendations:

  • Support team-based, interprofessional care through programs, policies and new reimbursement models. This will advance health equity by better ensuring that all MA enrollees receive the care they need.
  • Implement GTMRx payment and policy recommendations. These include compensating interprofessional care teams for delivering CMM services.
  • Address inequities in access to high-quality medication therapy through a National Pharmacoequity Initiative. This initiative would include regulatory changes that promote pharmacoequity through value-based care payment models that support person-centered interprofessional teams and CMM.
  • Broaden access to standardized CMM services through telehealth. This could be part of a broader pharmacoequity initiative to address the issue of pharmacy deserts and lack of access to medication management.
  • Pilot a “gold-card” approach to reduce the burden of prior authorization for medication when CMM is in place. This would eliminate prior authorization for a defined list of medications when clinical pharmacists provide CMM services as part of an interprofessional team.
  • Support value-based payment models that encourage team-based, interprofessional care across all CMS programs. Team-based care is considered the optimal approach to care delivery, but current payment models neither recognize its value nor provide sufficient incentives to support implementation.
  • Include an indication of access to a clinical pharmacist and CMM in MA plan descriptions; support development of an associated quality metric to include in Medicare Star ratings. CMS should include an indication of a health plan’s support for CMM, and that it subsequently supports the development of metrics to assess effectiveness.

“GTMRx believes that clinical pharmacists providing CMM services, in collaboration with primary care clinicians and other team members, can significantly contribute to the CMS Vision for Medicare,” Capps concluded.

CMS will use these and other RFI responses to inform potential future rulemaking or other policy development.

About the Get the Medications Right™ Institute
The GTMRx Institute is a catalyst for change that brings critical stakeholders together, bound by the urgent need to get the medications right. We are physicians, pharmacists, nurses, patients, health IT innovators, drug and diagnostics companies, consumer groups, employers, payers—aligned to save lives and save money through comprehensive medication management. By showcasing evidence and innovation, we motivate practice transformation and push payment and policy reform. Together, we ACT to champion appropriate, effective, safe and precise use of medication and gene therapies. Learn more at gtmr.org.

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