[Federal Register Volume 82, Number 230 (Friday, December 1, 2017)]
[Notices]
[Pages 56968-56969]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-25823]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Notice of a Pilot Program on Medication Therapy Management Under
the TRICARE Program
AGENCY: Office of the Secretary, Department of Defense.
ACTION: Notice of a Pilot Program.
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SUMMARY: Per Section 726 of the National Defense Authorization Act
(NDAA) for Fiscal Year (FY) 2015, the Department of Defense (DoD) is
implementing a 2-year Pilot Program, ``Pilot Program on Medication
Therapy Management Under TRICARE Program''. The Pilot Program will
provide Medication Therapy Management (MTM) services to promote
adherence and improve medication-related health outcomes for TRICARE
beneficiaries (Beneficiaries) with more than one chronic medical
condition and taking more than one medication. The Pilot Program will
be conducted in three types of pharmacy settings. The intent of this
Pilot Program is to evaluate the feasibility and desirability of
including MTM as part of the TRICARE Program.
DATES: The demonstration began on October 1, 2016, and will continue
for no less than two years.
FOR FURTHER INFORMATION CONTACT: Mr. David W. Bobb, Defense Health
Agency,
[[Page 56969]]
J-3 Pharmacy Operations Division, telephone 703-681-2890.
SUPPLEMENTARY INFORMATION:
A. Background
Medicare Part D plans already provide MTM/clinical pharmacy
services to Medicare beneficiaries at high risk of medication-related
problems. The design of the DoD Pilot Program will consider best
commercial practices in providing MTM services.
The value of including clinical pharmacists on the PCMH care team
is well documented in the literature as delivering improved outcomes,
better medication adherence, and supports the tenets of healthcare
reform including enhanced access, improved quality, reduced cost, and
enhanced patient safety.
Clinical pharmacists play a critical role in the success of care
provided through the PCMH model. Utilizing clinical pharmacists has
clearly shown the relationship between pharmacist involvement and
positive patient outcomes especially in the optimization of medication
therapy, medication adherence, and the reduction in polypharmacy users.
B. Description of the Pilot Program
Services will be offered by pharmacists at three different location
types: (1) MTFs with a pharmacist embedded supporting a PCMH, (2) MTF
pharmacies for beneficiaries who receive primary care services from
providers outside an MTF but bring their prescriptions to the MTF
pharmacy, and (3) pharmacies other than an MTF. MTM involves a
pharmacist in the review of prescription history where the pharmacist
works with the patient and their primary care provider to develop
action plans for any medication-related problems. The overall goal of
MTM is to open a dialogue with beneficiaries and include them in
medication-related decision-making to optimize drug therapy, reduce
medication-related problems, improve adherence to therapy, and improve
health outcomes. As stated in Section 726, NDAA FY15, the 2-year pilot
program's target population will be beneficiaries who have more than
one chronic medical condition and are taking more than one medication.
This pilot program will focus specifically on beneficiaries
diagnosed with at least three chronic medical conditions and taking
multiple medications. The following chronic medical conditions will be
considered for this pilot: Alzheimer's disease, Chronic Heart Failure,
Diabetes, Dyslipidemia, End-Stage Renal Disease, Hypertension,
Respiratory Disease (Asthma, Chronic Obstructive Pulmonary Disease
[COPD]), Rheumatoid Arthritis, Post-Traumatic Stress Syndrome,
Depression, and Polypharmacy. This is consistent with the intent of
Section 726, NDAA FY 2015 of more than one chronic medical condition
and taking more than one medication. Each site within the three
location types will target an enrollment of 400 beneficiaries over at
least 12 months, but not to exceed 24 months, providing up to 6 hours
of contact per beneficiary per year.
Selection for Location Type 1 will be from the existing PCMH
empaneled population. MTM services will be provided by a pharmacist
embedded in the PCMH. The following facilities will be included in the
pilot program for Location Type 1: Fort Campbell, Naval Station
Mayport, and Hill Air Force Base.
Location Type 2 will include beneficiaries who use MTF pharmacies
but receive medical care from providers in the purchased care sector.
Beneficiaries will be notified of their eligibility to participate in
the Pilot Program, and may choose to accept or decline participation.
Beneficiaries participating in the Pilot Program at this location type
generally do not receive primary care services from health care
providers at MTFs. The following facilities will be included in the
pilot program for Location Type 2: Fort Campbell, Marine Corps Base
Camp Pendleton, and Patrick Air Force Base.
Location Type 3 will provide MTM services for beneficiaries
receiving medical and pharmaceutical care outside of an MTF.
Beneficiaries will be notified of their eligibility to participate in
the Pilot Program, and may choose to accept or decline participation.
The following areas will be included in the pilot program for Location
Type 3: Denver, Colorado, Orlando, Florida, and Houston, Texas.
MTM services will be provided by a pharmacist to beneficiaries
empaneled in the pilot program. Appointments will be conducted face to
face, over the telephone, and/or by video conferencing. MTM services
will include a Comprehensive Medication Review (CMR) consisting of an
assessment of the beneficiary's medication regimen, a comprehensive
record of medications, a collaborative care agreement between the
beneficiary and the pharmacist, communication with the beneficiary's
healthcare providers, and documentation with follow up. CMR is
conducted at the initial visit and annually thereafter. Interim
Targeted Medication Reviews are offered quarterly to monitor unresolved
issues requiring attention and to determine if new drug therapy
problems have arisen. The pharmacist, in consultation with the
beneficiary, reviews pertinent medical and prescription history and
develops action plans to address medication-related problems.
C. Evaluation
The effect of MTM services on beneficiary use and outcomes of
prescription medications and the cost of health care will be evaluated
using established DoD metrics of Per Member Per Month (PMPM) and
Pharmacy PMPM. Additional measures may include a review of changes in
utilization of the emergency department, hospitalization rates and
readmission rates. Beneficiary use and outcomes of prescription
medications will assess medication adherence and disease related
outcomes measures, when available.
A report to Congress is required not later than 30 months after the
start of the Pilot.
Dated: November 27, 2017.
Aaron Siegel,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 2017-25823 Filed 11-30-17; 8:45 am]
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