Medication therapy management delivery by community pharmacists: Insights from a national sample of Medicare Part D beneficiaries

Introduction: The Medicare Part D medication therapy management (MTM) program positions pharmacists to optimize beneficiaries' medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types. Objectives: To (a) characterize Medicare Part D MTM delivery by community pharmacists, (b) compare MTM delivery by community pharmacists to other pharmacists, and (c) generate hypotheses for future research. Methods: A descriptive cross-sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen's Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers. Results: Among beneficiaries sampled, community pharmacists provided comprehensive medication reviews (CMRs) to 22% (n = 26 337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face-to-face. Across pharmacist cohorts, median days to CMR offer of post-MTM program enrollment were within the 60-day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more medication therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; P <.001), but resolved less MTPs (0.2 [0.7]; P <.001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (P <.001). Conclusion: Community pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by noncommunity pharmacists. Future research should explore geographic/racial-ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.