UnitedHealthcare, Humana, CVS join new value-based prescription model

The participants in CMS’s Medicare Part D model designed to incentivize medication adherence programs will include some of the largest insurers in the U.S.

The agency announced that UnitedHealthcare, Humana, WellCare, CVS Health, Blue Cross and Blue Shield (BCBS) of Florida and BCBS Northern Plains Alliance will participate in the model, dubbed Part D Enhanced Medication Therapy Management (MTM).

The model will be tested over five years in Part D regions covering Arizona, Florida, Iowa, Louisiana, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Virgina and Wyoming. CMS estimated the model will cover 1.6 million beneficiaries in its first year.

“Upon approval from CMS, the selected basic stand-alone [prescription drug plans] in these regions can vary the intensity and types of MTM interventions they provide based on beneficiary risk level and seek out a range of strategies to individualize beneficiary and prescriber outreach and engagement,” CMS said in a press release. “The selected PDPs can accomplish these goals by leveraging the core competencies of their own organizations, their network pharmacy providers, and prescribers to accurately identify and effectively intervene with beneficiaries whose issues with medication management have caused, or are likely to cause, adverse outcomes and/or significant non-drug program utilization and costs.”

Participants have some restrictions on how they can reach the targets set by the program. For instance, plans can’t restrict benefits or raise cost sharing to discourage beneficiaries from using medically necessary prescription. Beneficiaries will be allowed to opt out of Enhanced MTM items or services at any time.

Plans could receive a greater premium subsidy in future years if they reduce expected beneficiary fee-for-service expenditures by 2 percent.