Does the MAPD plan offer pharmacy-delivered MTM services or other pharmacy-based clinical interventions for its patients?
As part of the Medicare Modernization Act, all Part D and MAPD plans are required to have an MTM program for targeted high-risk beneficiaries. These plans are given flexibility to establish parameters for targeting these beneficiaries and how they administer the program. MAPDs are more likely than PDPs to have strong MTM and clinical programs because, while the MTM program may increase an MAPD plan’s prescription drug spending, the benefits on decreased hospitalizations and physician visits make up for this risk. • Does the MAPD plan offer adequate pharmacy reimbursement/dispensing fees? Congress intended for pharmacy reimbursement and price concessions to be negotiated. While many independent pharmacies accept all Part D contracts, the majority of independents are choosy about the contracts they accept. It is important to remember your costs of dispensing before accepting contracts. A recent Grant Thornton study found that the average pharmacy cost to dispense is $10.50 in chain and i
