The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for the Medication Therapy Management (MTM) program, effective January 1, 2025. These changes significantly impact how health plans and PBMs can participate and deliver high-quality MTM services to eligible beneficiaries. Read our following blog to discover how to navigate these CMS medication therapy management requirements.
The Evolving Landscape of Medication Therapy Management
The MTM program has evolved significantly since its establishment, reflecting the increasing complexity of medication regimens and the growing importance of patient-centered care. The 2025 updates reflect the evolution of the MTM program in several key ways:
- Broadened Eligibility: The program now includes individuals with HIV/AIDS and those living with a wider range of chronic conditions. This expanded eligibility provides a valuable opportunity for pharmacies to reach more patients and significantly improve their health outcomes through enhanced medication management services.
- Enhanced Patient-Centered Care: A strong emphasis is placed on interactive consultations and the inclusion of all Part D maintenance medications. This reflects a commitment to personalized care plans and a comprehensive approach to medication management, ensuring patients receive the most effective and appropriate support.
- Streamlined Processes: Recognizing the importance of efficiency, CMS has streamlined certain aspects of the MTM process, such as the cost threshold calculation. This aims to reduce the administrative burden on pharmacies, allowing them to focus more on providing high-quality patient care.
Addressing the Challenges of the 2025 MTM Program
While these updates offer significant opportunities, they also present challenges for health plans and PBMs. These include:
- Identifying Eligible Beneficiaries: Accurately identifying eligible beneficiaries within the expanded criteria requires robust data analytics and efficient patient screening processes.
- Implementing New Workflow Processes: Adapting workflows is essential to accommodate the expanded eligibility criteria, the inclusion of all Part D maintenance medications, and the enhanced requirements for CMRs.
- Ensuring Ongoing Compliance: Ensuring ongoing compliance with the evolving CMS guidelines is critical for the long-term success and sustainability of the MTM program.
How Agadia Can Help You in the Evolving MTM Landscape
Agadia’s comprehensive MTM solution is designed to address these challenges and empower pharmacies to succeed in the evolving MTM landscape. Our platform offers:
- Advanced Patient Identification: Utilize our sophisticated rules engine to accurately identify eligible beneficiaries based on the expanded criteria, maximizing your participation and revenue potential.
- Streamlined Workflow Automation: Automate key aspects of the MTM process, including patient enrollment, medication reviews, documentation, and reporting, to improve efficiency and reduce administrative burden.
- Enhanced Patient Engagement Tools: Leverage built-in scheduling tools, seamlessly integrate with third party vendors for expanded capabilities, and utilize the patient self-service portal for improved patient engagement.
- Robust Data Analytics and Reporting: Track every step of the MTM process to demonstrate the impact of your MTM program and identify areas for improvement and ensure compliance with CMS reporting requirements.
- Increased staff productivity: With RxMTM+, health plans and PBMs experience a boost in productivity due to automation and well-integrated processes. The system automates routine tasks and reduces the need for manual data entry, which minimizes errors and frees up staff to focus on more critical aspects of patient care and program management.
- Improved Quality of Care: By ensuring that all patient interactions and medication management processes are meticulously documented and accessible, RxMTM+ enhances the quality of care provided to patients. Better management of these therapies often results in improved patient outcomes, adherence, and overall satisfaction.
- Expert Guidance and Support: Benefit from ongoing support from our team of MTM experts, including access to training materials and personalized you are getting the most out of your RxMTM+ experience. At Agadia, we view our relationship with customers as a partnership, not merely a business transaction. We understand that Medication Therapy Management is constantly evolving. As such, our commitment extends beyond providing software solutions; we actively collaborate with our customers to implement enhancements to our solution to meet the latest industry standards and regulatory requirements set forth by CMS. By choosing Agadia, you’re not just selecting a software provider—you’re choosing a partner dedicated to enhancing the value and effectiveness of your MTM program, ensuring it delivers optimal outcomes for both your organization and the patients it serves.
The 2025 MTM updates offer health plans and PBMs a chance to improve patient care, outcomes, and their market position. Agadia’s MTM solution helps navigate these changes, optimize their programs, and achieve long-term success.
Schedule a demo today to learn how Agadia can help optimize your MTM program and improve patient outcomes.
Sources: Contract Year 2025 Medication Therapy Management (MTM) Program Guidance and Submission Instructions
