Medication Therapy
Management
Objectives
• Define Medication Therapy Management
(MTM)
• Identify the essential components of MTM
• Explain the importance of pharmacist
involvement in MTM services
What is MTM?
• Medication Therapy Management
• Services that assure medications are used to
– “optimize therapeutic outcomes through
improved medication use”
– “reduce the risk of adverse events, including
adverse drug interactions”
Where did MTM come from?
• Medicare Prescription Drug Improvement, and
Modernization Act of 2003
– Prescription Drug Plans (PDP) must have MTM
programs for Medicare Part D medications
– Development of the program requires collaboration with
a licensed PHARMACIST and physician
– Targeted towards specific patients
– Must pay pharmacist for services!!!
“Targeted Beneficiaries”
• Individuals with:
– Multiple chronic diseases
– Multiple part D drugs
– High drug costs
• Maximum expenditure is decided by the Secretary of
Health and Human Services
2010 Targeted
Beneficiary Requirements
• Must have “multiple” chronic diseases
– PDP cannot require more than 3 chronic diseases
– PDP can choose to accept any chronic diseases or limit enrollment
to specific diseases, but must target at least four of these conditions:
• Hypertension
• Heart failure
• Diabetes
• Dyslipidemia
• Respiratory disease
• Bone disease/arthritis
• Mental health
2010 Targeted
Beneficiary Requirements, cont’d
• Must take “multiple” Part D medications
– PDP cannot require more than 8 medications as
the minimum
• “High” drug costs
– 2009: patients had to be predicted to spend at
least $4000 on medications
– 2010: patients have to be predicted to spend at
least $3000 on medications
2010 Requirements for PDP
• Targeted patients must be automatically
enrolled in an MTM program, unless they
decided to “opt-out”
• PDP must enroll target patients at least
quarterly
• Must offer yearly comprehensive medication
review
• Must document outcomes
Elements of MTM
suggested by MMA 2003
• Educate patient
• Increase adherence
– Refill reminders
– Packaging
• Detect side effects
• Detect overuse/underuse
Elements of MTM
suggested by multiple national pharmacy organizations
• Performing or obtaining necessary assessments of the
patient’s health status
• Formulating a medication treatment plan
• Selecting, initiating, modifying, or administering
medication therapy
• Monitoring and evaluating the patient’s response to therapy,
including safety and effectiveness
• Performing a comprehensive medication review to identify,
resolve, and prevent medication-related problems, including
adverse drug events
Elements of MTM, cont’d
• Documenting the care delivered and communicating essential
information to the patient’s other primary care providers
• Providing verbal education and training designed to enhance
patient understanding and appropriate use of his/her
medications
• Providing information, support services and resources
designed to enhance patient adherence with his/her therapeutic
regimens
• Coordinating and integrating medication therapy management
services within the broader health care-management services
being provided to the patient
Providing MTM
• Setting
– Institutional
– Ambulatory/community
• Two types of MTM
– Point-of-care
– Comprehensive Medication Review
Point-of-Care
• Provided throughout the year
• Must be completed at least quarterly
• Assess medication use since CMR
• Monitor for unresolved issues
• Address new problems (ex: formulary interchange,
interactions)
• Counsel on new medications
• Does not have to involve direct patient
communication (may talk with provider)
Comprehensive Medication Review
• Review all medications (prescription, OTC,
herbal, supplements)
• Assess therapy and optimize outcomes
• 3 parts:
– Pre-work-up
– Patient Interview/Consultation
– Follow-up
Pre-Work-Up
• Initial review of medications (preparing for
the consultation):
– Drug Interactions
– Cost-saving opportunities
– Therapeutic Duplication/Suboptimal therapy
– Appropriateness of therapy
– Over-use/Under-use of medications
– Insufficient/Excessive dosing
– Lab Assessment
Consultation
• Face-to-face or by telephone
• Clarify allergies and medical conditions
• Assess
– Medication use/adherence
– Side effects and efficacy
– Goals of therapy and progress
– Understanding of medication therapy
– Administration technique
Consultation
• Other issues to assess
– Patient’s healthcare priorities
• Cost
• Comfort
• Convenience
• Simplifying therapy
– Language barriers
– Literacy level
– Cultural Issues
Follow-up
• Provider
– Document care provided
– Collaborate with provider to find solutions to medication therapy
issues
• Patient
– Provide Master Medication List, Plan for improvement,
Recommendations
– Assess improvement/decline in therapy
– Address additional questions/concerns
• Document
• Bill for services
MTM Platforms
• For billing and documentation
• Internet-based
• Outcomes Pharmaceutical Health Care
– Point-of-Care
– CMR (face-to-face only)
• MirixaPro
– CMR only (face-to-face and over-the-phone)
• Medication Pathfinder
– CMR only (face-to-face only)
Conclusions
• Pharmacists are an integral part of patient
care
• It’s important for pharmacists to take
advantage of opportunities to provide MTM
– Use your clinical skills
– Get valued for your expertise
– Get recognized and paid for your services
References
• Centers for Medicare & Medicaid Services
(CMS). Department of Health & Human
Services. March 30, 2009. Call Letter 2010.
p. 68-73
[http://www.cms.hhs.gov/PrescriptionDrugC
ovContra/Downloads/2010CallLetter.pdf]
• January 7, 2003. Medicare Prescription
Drug Improvement, and Modernization Act
of 2003. p. 20-22
