Medication Therapy Management

Linda Mach, PharmD

Bartell Drugs

Community Practice Resident

February 26, 2010

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 MTMsuggested by MMA 2003

• Educate patient

• Increase adherence– Refill reminders– Packaging

• Detect side effects

• Detect overuse/underuse

Elements of MTMsuggested 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/PrescriptionDrugCovContra/Downloads/2010CallLetter.pdf]

• January 7, 2003. Medicare Prescription Drug Improvement, and Modernization Act of 2003. p. 20-22