[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]
 BILLING CODE 5001-06-P