A Narrative Review of Medicare Part D Medication Therapy Management Program Design Challenges and the Development of an Evidence-Informed MTM Benefit Program for a Large Self-Insured Employer

The Medicare Part D Medication Therapy Management (MTM) program has several well-documented challenges, including restrictive eligibility criteria, low patient engagement, and difficulties integrating MTM services into pharmacy workflows and broader healthcare teams. These challenges are often driven by inadequate health information technology infrastructure, limited coordination between pharmacists and prescribers, and inefficiencies in standardized documentation for Comprehensive Medication Reviews (CMRs). This narrative review synthesized published literature to identify challenges and limitations of the Medicare Part D MTM program and used Purdue University’s MTM program design documentation to compare program features and describe the evidence and rationale underlying key design decisions. Purdue’s MTM program incorporated broader patient eligibility, more frequent MTM services, and provider-developed communication templates to address limitations in patient access, program uptake, and workflow feasibility identified in the Medicare Part D program. However, challenges related to optimization of standardized CMR documentation and integration with electronic health records (EHRs) remained unresolved. Overall, this review demonstrates how evidence-informed program design may strengthen MTM implementation while identifying opportunities for future refinement. Future evaluation of the Purdue MTM program will assess its acceptability, feasibility, adoption, reach, and fidelity.