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2 0 0 6 C O N S E N S U S D O C U M E N T
Sound Medication TherapyManagement Programs
This document is endorsed or supported by the following organizations:
n AARP
n Academy of Managed Care Pharmacy
n American College of Clinical Pharmacy
n American Geriatrics Society
n American Pharmacists Association
n American Society of Consultant Pharmacists
n Case Management Society of America
n College of Psychiatric and NeurologicPharmacists
n Department of Veterans Affairs
Copyright © 2006, Academy of Managed Care Pharmacy. All rights reserved.
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PrefaceSpurred by the Medicare Modernization Act’s (MMA’s) inclusion of the medication therapymanagement (MTM) requirement, the Academy of Managed Care Pharmacy (AMCP) andother organizations recognized that there was a lack of clear definition of what specific elements would comprise a quality MTM program. In order to fill that gap, the Academyassembled a variety of stakeholder organizations that were willing to work to build a consensus document that would define those elements.
The stakeholder group used interactive discussion through both face-to-face meetings and e-mail correspondence in the drafting of the document. AMCP was responsible forassembling the work group and for the drafting and dissemination of the document. This initiative was funded through a restricted grant from Merck/Schering-Plough (MSP).
The stakeholder work group consisted of:
n AARP
n Academy of Managed Care Pharmacy
n American Academy of Family Physicians
n American Geriatrics Society
n American Pharmacists Association
n American Society of Consultant Pharmacists
n Case Management Society of America
n Department of Veterans Affairs
n National Business Coalition on Health
In order to gain insight from health care professionals who had built MTM programs,AMCP identified and recruited a resource panel of 15 representatives from health plans,pharmacy benefit management companies and integrated health care systems. The individualsbrought expertise in medication therapy improvement and served as a resource for the stake-holder group while the consensus paper was being developed.
The project facilitator used an interview instrument developed by the stakeholder workgroup to solicit input from the resource panel. The resource panel input ensured that the con-sensus paper had applicability in real-world health care practice. These resource organizationsalso had the opportunity to review and comment on a draft of the consensus document.
Additionally, other pharmacy organizations provided input on drafts of the document. We are pleased to have received comments from the American Association of Colleges ofPharmacy, the American Society of Health-Systems Pharmacists, the College of Psychiatricand Neurologic Pharmacists and the National Association of Chain Drug Stores.
The project began in September 2005; the draft document was completed by February2006. AMCP contracted with Pete Penna, PharmD, to facilitate the stakeholder meetings,conduct interviews with the resource panel and draft the document.
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IntroductionThe purpose of this document is to help guide designers of medication therapy management(MTM) programs to identify the critical elements that support an effective, quality MTMprogram and allow them to be constructive in encouraging positive patient outcomes. Thisguide also can help purchasers of MTM programs evaluate the quality of those programs andprovide a basis for assessing programs established by Medicare Part D plan sponsors andother MTM program sponsors.
MTM programs are developed by health plans or other health care entities focused onoptimizing patient therapeutic outcomes. MTM services are components of MTM programsand are delivered by health care professionals.
This document is not intended to be a prescriptive document, to imply oversight or in anyway to impinge creativity or innovation. MTM programs by their nature should be evolving,flexible and responsive to patient and health care system needs.
BackgroundFor modern prescription medication therapies to be most effective, several things must occur:
n The right medication must be prescribed at the correct dose and for the proper duration.
n The medication must be accessible to the patient. The patient must get the prescriptionfilled and must be adherent to the therapy.
n Patients must be monitored to ensure that best outcomes are achieved, that the objectivesof therapy are being met and that adverse events are minimized.
n Patients and caregivers must be properly educated and counseled and their medicationtherapy properly managed.
This is particularly true for patients who are at high risk as a result of chronic medical condi-tions and/or complex medication regimens. MTM programs that implement effective MTMservices greatly enhance patient care, leading to improved overall health, while at the sametime decreasing overall health care system costs by reducing improper medication use, pre-venting adverse drug events and other undesirable outcomes and supporting achievement oftherapeutic goals (see Appendix B for examples).
The Medicare Modernization Act (MMA) recognizes the value of medication therapymanagement. The Act requires prescription drug plans (PDPs) and Medicare Advantageplans (MA-PDs) that offer prescription drug coverage to have a medication therapy manage-ment program for those beneficiaries who meet high-risk eligibility criteria. As defined in theMedicare prescription drug benefit regulations issued by the Centers for Medicare andMedicaid Services (CMS), MTM programs are defined as programs of drug therapy manage-ment whose goal is to ensure that medications provided to the eligible beneficiaries areappropriately used to (a) optimize therapeutic outcomes through improved medication useand (b) reduce the risk of adverse events.
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There are cases of self-insured employers and state Medicaid programs turning to MTMservices as well, in order to ensure that medications are being used to optimize outcomes.1,2
While such activities are not yet widespread, they are increasing and are an indication ofthings to come. In addition, there are well-documented activities that fit the MTM definitionthat have been introduced in such diverse settings as the Veterans Administration, healthplans, integrated health systems, hospitals and community pharmacies. Examples include:
n Drug therapy management clinics, such as anticoagulation clinics; transplant programs;and HIV, hepatitis C, psychiatric and lipid management clinics. These programs are set upto ensure that patients are taking their medications correctly and that drug-related prob-lems are identified and managed. For example, anticoagulation clinics are typically run byan integrated health system or hospital to manage patients who require anticoagulationtherapy. Such clinics have been documented to reduce hospitalizations, morbidity andmortality in patients who must use these medications.
n Comprehensive medication reviews conducted by pharmacists (e.g., “brown-bag” pro-grams). These are programs in which a patient brings all the medications they are taking(prescription, nonprescription and dietary supplements) to their pharmacist, physician orother health care provider to review the appropriateness of each medication and ensurethat the patient is taking them correctly, to avoid drug-related problems.
n Drug utilization review projects and other programs dealing with appropriate medicationtherapy or patient safety. Managed care organizations and providers often run computerprograms to identify patients at risk for specific medication problems. Examples includescreening to identify asthmatics or congestive heart failure patients not using appropriatemedications and patients prescribed antidepressants who have discontinued their medica-tions early.
n Prescription drug adherence clinics and case management adherence programs. These areprograms set up to identify patients who have been prescribed a medication for a chroniccondition (e.g., diabetes, lipid disorders, asthma, psychiatric problems, hypertension) whoare no longer taking their medication against medical advice. The goal of the program isto increase the number of patients who are adherent with their medication therapy, there-by achieving positive clinical outcomes.
Medication therapy management programs are of significant interest to several health profes-sions since it is anticipated and expected that they would play key roles in such programs. Asthese professions come together to determine how best to deliver such programs and servic-es, they are searching for guidance as to how these programs might be structured. The needfor consensus on the essential components of an MTM program springs from two currentfactors:
n First, experience shows that the Medicare program establishes precedents in coverage deci-sions that are often replicated in both state-based health care programs and the privatesector. Based on this history, it can be anticipated that MTM programs may become aroutine part of health care in this country. Since there are costs associated with providingthese services, it will be important to define successful business models, including incen-tives, that are based on a widely accepted understanding of what comprises an appropriateMTM program.
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n Second, to date, CMS has chosen not to issue a strict definition of what constitutes anacceptable MTM program. Although there are some experiences with medication therapymanagement, there is not one universally accepted set of parameters that can adequatelydefine MTM services. CMS encourages the multiple Part D sponsors to be innovative inthe approaches used to meet the Medicare requirement for offering an MTM program.These innovations will target a variety of patients with a broad array of diagnoses thatdepend on appropriate medication therapy to generate positive patient outcomes. It isexpected that once CMS has data from two or more years of implementation of MTMprograms, the agency will be able to identify those programs that work most effectivelyand that these approaches will be the basis for future regulatory oversight and guidance inthis area.
Spurred by the MMA’s inclusion of the MTM program requirement, numerous initiativeshave been undertaken to define medication therapy management services. In 2004, a groupof 11 national pharmacy organizations developed a consensus document on the service andprogram components of medication therapy management.3 In 2005, the AmericanPharmacists Association and the National Association of Chain Drug Stores Foundationdeveloped a model guide for community pharmacists to use in effectively delivering MTMservices in the community setting.4 Additionally in 2005, the Academy of Managed CarePharmacy and the American Society of Health-System Pharmacists published the results of anexecutive session convened to discuss the implementation of medication therapy managementunder the Medicare Part D benefit.5
What is lacking today is a clear identification of what elements would constitute a qualitymedication therapy management program. From a programmatic standpoint, MTM pro-grams are in a formative stage with no specific “best practices” or quality assurance standardshaving been fully articulated or evaluated. Although definitions and frameworks for MTMservices have been drafted, no detailed guidelines have been established for MTM programs.This consensus document addresses that gap by outlining the critical elements for an MTMprogram to be considered high quality. The members of the organizations represented onthis consensus panel are in the best position to help define these elements. The settings theyrepresent find value in the interdisciplinary systematic approach to quality care delivery that isan essential piece of organized patient care both at the population and individual patientlevel. Included in the consensus is input from additional organizations dedicated to establish-ing sound MTM programs.
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Important Features of a Quality MTM Program
The safe, effective, appropriate and economical use of medications is the overarching goal ofMTM programs. In order to achieve these objectives, MTM designers should consider sever-al elements. The following list comprises features, principles and approaches to MTM thatthe consensus group believes are important elements of a quality MTM program:
n Patient-centered approach. Effective management of a patient should consider suchaspects of that patient’s environmental, social and medical status that may be factors. Apatient-centered approach to managing and implementing MTM programs will helpensure that the correct medication, including dose and dosing regimen, is prescribed. It isinherent in such an approach that decisions will be made based on current and accuratemedical information.
n Interdisciplinary, team-based approach. Services offered by MTM programs should bedelivered by an interdisciplinary MTM team led by a qualified pharmacist or other healthcare professional; team members should have expertise in the specifics of the medicationsin question. The inclusion of different perspectives will often highlight problems that maybe unforeseen when only the prescriber and patient are involved. Ineffective use of med-ications is a multifactorial problem. Effective MTM programs address these factors as wellas the root causes of suboptimal use of medications and the fundamental changes that willbe necessary. No single health care professional has all of the answers to all of these prob-lems for all patients. Therefore, MTM programs may involve representatives of a variety ofprofessions so that more effective programs can be delivered.
n Communication. Effective communication and sharing of pertinent care informationbetween those parties involved in the prescribing, dispensing, monitoring and educationalcomponents are vital to the successful use of medications.
n Population and individual patient perspective. MTM programs are developed for targetpatient populations so that services can be individually delivered to patients.
n Flexibility for broad applications. Programs can be designed and implemented toaddress the needs of additional at-risk patient populations.
n Evidence-based medicine. The adoption and application of evidence-based medicine is agrowing force in health care. There should be recognition that best practices predicated onrigorously applied evidence-based medicine should be incorporated into MTM programs.
n Promotion of MTM services. Mutual promotion of MTM by health plans and healthcare professionals can help enhance adoption.
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Operational Aspects of Quality MTM Programs
The following list consists of specific operational elements that the consensus group identi-fied as components of quality MTM programs. This list is not meant to be prescriptive:
1. Patient identification and recruitment. There should be a process to identify andthen to enroll the pool of patients at risk for adverse events and those likely to suffer pooroutcomes. Programs should identify both the process and accountability for identification ofsuch patients. Lists of eligible patients should be updated frequently. Patients at risk couldinclude those who
n are over- or under-utilizers of medications;
n visit multiple physicians;
n routinely are not adherent to or persistent with medication regimens;
n do not understand how to use their medications and do not have a support system/network in place to guide their utilization;
n have financial barriers to obtaining their prescriptions, including those who use veryexpensive medications or have very high total drug expenses; and
n need multiple medications to treat complex comorbidities.
Patients could be identified by an MTM program, a health plan or other health care entity, aprovider and/or patient self-referral.
2. Services to meet the needs of individual patients. There are a number ofpotential activities that might be undertaken by quality MTM programs, targeted to theneeds of individual patients. While not an all-inclusive list, there is a catalogue of nine serviceactivities identified by a group of 11 national pharmacy organizations in a July 2004 consen-sus statement (see Appendix A for this report). This is not intended to be a definitive list,and it is not suggested that any given program must contain all of these elements. The itemslisted are offered as examples of the types of activities that quality MTM programs mightemploy. In addition, it is recognized that interdisciplinary care should be encouraged, appro-priately utilizing skill sets of different health care providers. Qualified pharmacists are in aunique position to manage MTM programs.
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3. Services tailored for setting, cultural differences. Programs should use methodsappropriate to meet the needs of the targeted patient population. Patient demographics and health conditions to be considered include such elements as the patient’s residence (institutional, multiple, undefined), cultural diversity, health literacy and language barriers.Appropriate methods of delivering information to and communicating with patients shouldaccount for such factors in the design.
4. Coordination of care. An emphasis on coordination of care rather than perpetuationof fragmented care can improve patient outcomes. This may be accomplished by
n establishing processes that allow appropriate sharing and communication of patient information among health care providers who have a need to know (such processes shouldbe able to identify those practitioners who need to have access to this information),
n maximizing the productivity of MTM providers through appropriate use of informationtechnology as well as other communication tools and
n providing a capability that allows one provider to refer patients to another.
It is noted that the technology of e-prescribing and electronic medical records may promote efforts to coordinate care.
5. Appropriate documentation and measurement. MTM programs will need toidentify and perform a variety of measurements and document program results in order todetermine overall program effectiveness and achievements. Examples include:
n Patient satisfaction
n Services that are provided and by whom (type of health care professional or other person)
n Desired treatment outcomes and results achieved (economic, clinical or humanistic)
6. Quality assurance. Given concerns about the quality of health care, MTM programswill need to address the issue of quality assurance. Longitudinal assessment of program quali-ty should be incorporated into program design to ensure that program goals are met. Specificareas that could be addressed include:
n Achievement of quality targets measured by both internal and external metrics
n Identification and appropriate use of best practices
n Application of evidence-based medicine, as appropriate
7. Communications by the MTM program. Effective communications with planmembers and providers will be integral to the success of MTM programs. Considerations forsuch communications should include that they are
n regular and ongoing;
n descriptive of the benefits and limitations, including opt-in and opt-out opportunities; and
n descriptive of how long patients remain enrolled once they enter the program.
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8. Practitioners who can coordinate and provide MTM. Programs may bedeli’vered by and involve a variety of health care professionals. The list of potential providersmight include:
n Pharmacists employed by a pharmacy, health plan, PBM, hospital, other health care entityor as an independent provider of care
n Other qualified health care professionals
Continuing education and training of MTM providers on services, access to care and interventions will be necessary for success.
9. Adoption of standardized documentation, billing and payment systems.Programs should include standardized documentation, billing and payment systems forMTM services.
References1. Cranor CW, Bunting BA, Christensen DB. The Asheville project: long-term clinical and
economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc.2003;43:173-90.
2. Chrischilles EA, Carter BL, Lund BC, et al . Evaluation of the Iowa Medicaid pharmaceu-tical case management program. J Am Pharm Assoc. 2004;44:337-49.
3. Bluml B. Definition of medication therapy management: development of profession-wideconsensus. J Am Pharm Assoc. 2005;45:566-72.
4. American Pharmacists Association and National Association of Chain Drug StoresFoundation. Medication therapy management in community pharmacy services: core ele-ments of an MTM service (I version 1.0). Am Pharm Assoc. 2005;45:573-79. Available at:http://www.aphanet.org/AM/Template.cfm?Template=/CM/ContentDisplay.cfm&ContentID=3303. Accessed July 5, 2005.
5. Summary of the executive sessions on medication therapy management programs,Bethesda, Maryland, June 14 and August 18, 2004. Medication therapy management pro-grams: to optimize pharmacy outcomes [letter]. J Manag Care Pharm. 2004;11(2):179-86. Available at: http://www.amcp.org/data/jmcp/Letters-179-186.pdf. Accessed February10, 2006.
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Appendix AMedication Therapy Management Services
Definition and Program Criteria
Approved: July 27, 2004,by the Academy of Managed Care Pharmacy, American Association of Colleges of Pharmacy,
American College of Apothecaries, American College of Clinical Pharmacy,American Society of Consultant Pharmacists, American Pharmacists Association,
American Society of Health-System Pharmacists, National Association of Boards of Pharmacy,**National Association of Chain Drug Stores, National Community Pharmacists Association
and National Council of State Pharmacy Association Executives
Medication Therapy Management is a distinct service or group of services that optimize ther-apeutic outcomes for individual patients. Medication Therapy Management services are inde-pendent of, but can occur in conjunction with, the provision of a medication product.Medication Therapy Management encompasses a broad range of professional activities andresponsibilities within the licensed pharmacist’s, or other qualified health care provider’s,scope of practice. These services include but are not limited to the following, according tothe individual needs of the patient:
a. Performing or obtaining necessary assessments of the patient’s health status
b. Formulating a medication treatment plan
c. Selecting, initiating, modifying, or administering medication therapy
d. Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness
e. Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events
f. Documenting the care delivered and communicating essential information to the patient’s other primary care providers
g. Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications
h. Providing information, support services, and resources designed to enhance patient adherence with his/her therapeutic regimens
i. Coordinating and integrating medication therapy management services within the broader health care management services being provided to the patient
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A program that provides coverage for Medication Therapy Management services shallinclude:
a. Patient-specific and individualized services or sets of services provided directly by a pharmacist to the patient.* These services are distinct from formulary development and use, generalized patient education and information activities, and other population-focused quality assurance measures for medication use.
b. Face-to-face interaction between the patient* and the pharmacist as the preferred methodof delivery. When patient-specific barriers to face-to-face communication exist, patientsshall have equal access to appropriate alternative delivery methods. Medication TherapyManagement programs shall include structures supporting the establishment and maintenance of the patient*–pharmacist relationship.
c. Opportunities for pharmacists and other qualified health care providers to identify patients who should receive Medication Therapy Management services.
d. Payment for Medication Therapy Management services consistent with contemporaryprovider payment rates that are based on the time, clinical intensity, and resourcesrequired to provide services (e.g., Medicare Part A and/or Part B for Current ProceduralTerminology [CPT] and Resource-Based Relative Value Scale [RBRVS]).
e. Processes to improve continuity of care, outcomes, and outcome measures.
* In some situations, Medication Therapy Management services may be provided to the caregiver or other persons involved in the care of the patient.
**Organizational policy does not allow NABP to take a position on payment issues.
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Appendix BEvidence of the Pharmacists’ Value:
An Overview of Several Landmark Studies
Reprinted from:
Medication Therapy Management Services:A Critical Review
Prepared for the American Pharmacists Association byThe Lewin Group
May 17, 2005
Note: The Executive Summary of this report is available at www.aphanet.org.
To obtain a copy of the complete report, contact the American Pharmacists Association at 202-429-7559.
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rugs
,nu
mbe
r of
dos
es p
erda
y, 6
-mon
th d
rug
cost
s, p
atie
nt-
repo
rted
adve
rse
effe
cts
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
13
2 0 0 6 C O N S E N S U S D O C U M E N T — A P P E N D I X B
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Chr
isten
sen
D, N
eil N
,Fa
sset
t W
, Sm
ith D
, Hol
mes
G, S
terg
achi
s A
. (20
00).
Freq
uenc
y an
d ch
arac
teris
tics
of c
ogni
tive
serv
ices
pro
vide
din
res
pons
e to
a fi
nanc
ial
ince
ntiv
e. J
Am
Pha
rm A
ssoc
,40
: 609
–617
.
Pros
pect
ive
ran-
dom
ized
tria
l 11
0 st
udy
phar
mac
ies
(fin
anci
al in
terv
entio
n);
90 c
ontr
ol p
harm
acie
s
Stud
y ph
arm
acist
s do
cum
ente
d an
aver
age
of 1
.59
CS
inte
rven
tions
per
100
pres
crip
tions
ver
sus
con-
trol
s do
cum
entin
g an
ave
rage
of
0.69
CS
inte
rven
tions
per
100
pre
-sc
riptio
ns. T
he a
vera
ge s
elf-
repo
rted
time
to p
erfo
rm C
S w
as 7
.5 m
in-
utes
, with
75%
last
ing
few
er t
han
6m
inut
es. F
inan
cial
ince
ntiv
e as
soci
-at
ed w
ith s
igni
fican
tly m
ore
and
dif-
fere
nt t
ypes
of C
S pe
rfor
med
by
phar
mac
ists.
Num
ber
of c
ogni
tive
serv
ice
(CS)
inte
rven
-tio
ns p
er 1
00 p
resc
rip-
tions
ove
r 20
-mon
thpe
riod
Man
asse
HR
. (19
89).
Med
icat
ion
use
in a
n im
per-
fect
wor
ld: D
rug
misa
dven
tur-
ing
as a
n iss
ue o
f pub
lic p
oli-
cy. P
art
1. A
m J
Hos
p Ph
arm
,46
: 929
–944
.
Rev
iew
T
wel
ve t
hous
and
deat
hs a
nd 1
5,00
0ho
spita
lizat
ions
wer
e re
port
ed t
oth
e FD
A, b
ut t
he n
umbe
r of
adve
rse
drug
rea
ctio
ns m
ight
be
asm
all f
ract
ion—
perh
aps
only
10%
of
the
true
num
ber.
Dea
ths
and
hosp
italiz
a-tio
ns d
ue t
o ad
vers
edr
ug r
eact
ions
Boo
tman
JL
, Har
rison
DL
,C
ox E
. (19
97).
The
hea
lthca
re c
ost
of d
rug-
rela
ted
mor
-bi
dity
and
mor
talit
y in
nur
s-in
g fa
cilit
ies.
Arc
h In
t M
ed,
157:
208
9–20
96.
Dec
ision
ana
lysis
B
asel
ine
estim
ates
indi
cate
tha
t th
eco
st o
f dru
g-re
late
d m
orbi
dity
and
mor
talit
y w
ith t
he s
ervi
ces
of c
on-
sulta
nt p
harm
acist
s w
as $
4.0
billi
onve
rsus
$7.
6 bi
llion
with
out
the
serv
-ic
es o
f con
sulta
nt p
harm
acist
s.
Cos
t of
dru
g-re
late
dm
orbi
dity
in n
ursin
gfa
cilit
ies
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
14
S O U N D M E D I C A T I O N T H E R A P Y M A N A G E M E N T P R O G R A M S
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
John
ston
AM
, Doa
ne K
,Ph
ipps
K, B
ell A
. (Ja
n 19
96).
Out
com
es o
f pha
rmac
ists’
cogn
itive
ser
vice
s in
the
long
-te
rm c
are
sett
ing.
Con
sPh
arm
, 11(
1): 4
1–50
.
Cha
rt r
evie
w10
,207
res
iden
t ch
art
revi
ews
of d
rug
regi
-m
en c
olle
cted
ove
r 1-
mon
th p
erio
d of
122
long
-ter
m c
are
faci
li-tie
s; c
hart
rev
iew
ove
r3-
mon
th m
onito
ring
perio
d
Phar
mac
ists
mad
e 3,
464
inte
rven
-tio
ns. R
espo
nse
rate
for
inte
rven
-tio
ns r
eque
stin
g a
resp
onse
was
85.7
%, w
ith a
68%
acc
epta
nce
rate
.A
ccep
ted
reco
mm
enda
tions
res
ulte
din
a t
otal
cos
t sa
ving
s of
$15
,111
.38
for
the
1-m
onth
per
iod.
Acc
epte
dre
com
men
datio
ns r
esul
ted
in fa
vor-
able
hea
lth o
utco
mes
99.
5% o
f the
time.
Num
ber
and
type
of
inte
rven
tions
, cha
nge
in d
rug
ther
apy,
cha
nge
in m
edic
atio
n co
st,
chan
ge in
pat
ient
heal
th
McM
ullin
ST
, Hen
nenf
ent
JA, R
itchi
e D
, Hue
y W
Y,L
oner
gan
T, S
chai
ff R
, Ton
nM
, Bai
ley
TC
. (19
99).
Apr
ospe
ctiv
e ra
ndom
ized
tria
lto
ass
ess
the
cost
impa
ct o
fph
arm
acist
-initi
ated
inte
rven
-tio
ns. A
rch
Int
Med
, 159
:23
06–2
309.
Pros
pect
ive
ran-
dom
ized
con
-tr
olle
d tr
ial
1,22
6 in
terv
entio
ns b
ysix
pha
rmac
ists
at la
rge
univ
ersit
y ho
spita
l
Cos
t-sa
ving
inte
rven
tions
invo
lved
stre
amlin
ing
ther
apy
to le
ss-e
xpen
-siv
e ag
ents
(39
%),
disc
ontin
uing
an
unne
cess
ary
med
icat
ion
(25%
), a
ndm
odify
ing
rout
e of
adm
inist
ratio
n(2
4%).
Int
erve
ntio
n gr
oup
had
drug
cost
s 41
% lo
wer
tha
n co
ntro
l gro
up(P
< .0
01).
Mea
n $4
3.40
ver
sus
$73.
75.
Dru
g co
sts
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
15
2 0 0 6 C O N S E N S U S D O C U M E N T — A P P E N D I X B
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Schm
ader
KE
, Han
lon
JT,
Piep
er C
F, S
loan
e R
, Rub
yC
M, T
wer
sky
J, F
ranc
is M
A,
Wei
nber
ger
M, F
euss
ner
J,C
ohen
HJ.
(20
04).
Eff
ects
of
geria
tric
eva
luat
ion
and
man
-ag
emen
t on
adv
erse
dru
gre
actio
ns a
nd s
ubop
timal
pre
-sc
ribin
g in
the
frai
l eld
erly
.A
m J
Med
, 116
: 394
– 40
1.
Ran
dom
ized
2x2
fact
oria
lco
ntro
lled
stud
y
834
patie
nts
in 1
1 V
Aho
spita
ls ov
er a
ge 6
5w
ho m
et c
riter
ia fo
rfr
ail f
ollo
wed
for
12m
onth
s—bl
inde
dph
ysic
ian-
phar
mac
istpa
irs
Out
patie
nt g
eria
tric
clin
ic c
are
resu
lted
in 3
5% r
educ
tion
in t
he r
iskof
ser
ious
dru
g re
actio
n (a
djus
ted
rela
tive
risk,
0.6
5; 9
5% C
I, 0
.45-
0.93
). I
npat
ient
ger
iatr
ic u
nit
care
redu
ced
unne
cess
ary
and
inap
pro-
pria
te d
rug
use
and
unde
ruse
sig
nif-
ican
tly (
P <
.05)
. Out
patie
nt g
eri-
atric
car
e re
duce
d th
e nu
mbe
r of
omitt
ed d
rugs
(P
< .0
5).
Risk
of s
erio
us a
dver
sedr
ug r
eact
ions
, unn
ec-
essa
ry a
nd in
appr
opri-
ate
drug
use
and
unde
ruse
Bro
oks
JM, M
cDon
ough
RP,
Dou
cett
e W
R. (
Jun
2000
).C
ost
anal
ysis:
Pha
rmac
istre
imbu
rsem
ent
for
phar
ma-
ceut
ical
car
e se
rvic
es: W
hyin
sure
rs m
ay fl
inch
. Dru
gB
enef
it T
rend
s, 4
5–62
.
Eco
nom
ic c
ost
anal
ysis
Res
earc
hers
dev
elop
ed c
ompl
ex e
co-
nom
ic m
odel
des
crib
ing
mor
al h
az-
ard,
pro
ving
tha
t en
rolli
ng h
igh-
risk
patie
nts
into
pha
rmac
eutic
al c
are
prog
ram
s ca
n be
of v
alue
to
insu
rers
if th
e sa
ving
s in
curr
ed is
mor
e th
anth
e pr
ogra
m e
xpen
se. B
ased
on
the
mod
el, a
utho
rs c
oncl
ude
that
rei
m-
burs
ing
phar
mac
ists
to p
rovi
deph
arm
aceu
tical
car
e is
optim
al if
are
lativ
ely
inex
pens
ive
patie
nt s
cree
n-in
g m
etho
d is
avai
labl
e th
at e
nabl
esin
sure
rs t
o lim
it vi
sits
to t
hose
patie
nts
who
off
er c
ost
savi
ngs
toth
e in
sure
r.
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
16
S O U N D M E D I C A T I O N T H E R A P Y M A N A G E M E N T P R O G R A M S
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Chr
isten
sen
D, T
rygs
tad
T,
Sulli
van
R, G
arm
ise J
, Weg
ner
S. (
Dec
200
4). A
pha
rmac
ym
anag
emen
t in
terv
entio
n fo
rop
timiz
ing
drug
the
rapy
for
nurs
ing
hom
e pa
tient
s. A
m J
Ger
iatr
Pha
rmac
othe
r, 2(
4):
248–
256.
Bef
ore-
afte
rde
sign
Doc
umen
ted
DR
R fo
r9,
208
resid
ents
in 2
53nu
rsin
g ho
mes
rec
eiv-
ing
18 o
r m
ore
pre-
scrip
tion
refil
ls in
90
days
Bas
elin
e m
ean
was
9.5
2 pr
escr
ip-
tions
per
mon
th, w
ith m
ean
drug
cost
of $
502.
96 t
o N
orth
Car
olin
aM
edic
aid
prog
ram
. Aft
er in
terv
en-
tion,
mea
n re
duct
ion
of 0
.21
occu
rred
in n
umbe
r of
pre
scrip
tions
per
mon
th, w
ith m
ean
redu
ctio
n in
drug
cos
t of
$30
.33
per
patie
nt p
erm
onth
.
Num
ber
of p
resc
rip-
tions
per
mon
th, d
rug
cost
s
Lip
ton
HL
, Ber
o L
A, B
ird
JA,
McP
hee
SJ. (
Jul 1
992)
. The
impa
ct o
f clin
ical
pha
rmac
ists’
cons
ulta
tions
on
phys
icia
ns’
geria
tric
dru
g pr
escr
ibin
g.M
ed C
are,
30(
7): 6
46–6
58.
Pros
pect
ive
ran-
dom
ized
con
-tr
olle
d tr
ial
236
patie
nts
age
65+
with
thr
ee +
med
ica-
tions
, 123
exp
erim
en-
tal,
113
cont
rols
from
a 45
0-be
d ho
spita
l
Exp
erim
enta
ls w
ere
less
like
ly t
oha
ve o
ne o
r m
ore
pres
crib
ing
prob
-le
ms
(P <
.05)
; exp
erim
enta
l dru
gre
gim
ens
wer
e m
ore
appr
opria
teth
an t
hose
of c
ontr
ols
(P <
.01)
.
Dru
g th
erap
y pr
ob-
lem
s, r
egim
en a
ppro
-pr
iate
ness
Cra
nor
CW
, Bun
ting
BA
,C
hrist
ense
n D
B. (
Mar
/A
pr20
03).
The
Ash
evill
e pr
ojec
t:L
ong-
term
clin
ical
and
eco
-no
mic
out
com
es o
f a c
omm
u-ni
ty p
harm
acy
diab
etes
car
epr
ogra
m. J
Am
Pha
rm A
ssoc
,43
(2):
173
–190
.
Qua
si-ex
peri-
men
tal l
ongi
tu-
dina
l pre
-pos
tco
hort
stu
dy
136
empl
oyee
s ha
ving
diab
etes
follo
wed
for
5ye
ars—
inte
rven
tion
ofed
ucat
ion,
con
sulta
-tio
ns, c
linic
al a
sses
s-m
ent,
goal
set
ting,
col
-la
bora
tive
drug
the
rapy
man
agem
ent
with
phys
icia
ns
Mea
n A
1c d
ecre
ased
at
all f
ollo
w-
ups,
mor
e th
an 5
0% o
f pat
ient
sde
mon
stra
ted
impr
ovem
ents
at
each
follo
w-u
p, n
umbe
r of
pat
ient
s w
ithop
timal
A1c
incr
ease
d at
eac
h fo
l-lo
w-u
p, a
nd >
50%
impr
oved
in li
pid
leve
ls. C
osts
shi
fted
from
inpa
tient
and
out-
patie
nt s
ervi
ces
from
phy
si-
Cha
nges
in g
lyco
syla
t-ed
hem
oglo
bin
(A1c
)an
d se
rum
lipi
d co
n-ce
ntra
tions
, cha
nges
indi
abet
es-r
elat
ed a
ndto
tal m
edic
al u
se, c
osts
over
tim
e
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
cont
inue
d
17
2 0 0 6 C O N S E N S U S D O C U M E N T — A P P E N D I X B
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Cra
nor
CW
, Bun
ting
BA
,C
hrist
ense
n D
B. (
Mar
/A
pr20
03).
cian
s to
pre
scrip
tions
, mea
n di
rect
m
edic
al c
osts
dec
reas
ed b
y$1
,200
.00
to $
1,87
2.00
per
pat
ient
per
year
, and
sic
k da
ys d
ecre
ased
for
one
empl
oyer
gro
up, w
ith in
crea
ses
in p
rodu
ctiv
ity e
stim
ated
at
$18,
000.
00 a
nnua
lly.
Wal
ker
S, W
illey
CW
. (20
04).
Impa
ct o
n dr
ug c
osts
and
uti-
lizat
ion
of a
clin
ical
pha
rma-
cist
in a
mul
tisite
prim
ary
care
med
ical
gro
up. J
Man
ag C
are
Phar
m, 1
0(4)
: 345
–354
.
Ret
rosp
ectiv
epr
etes
t po
stte
stst
udy
Inde
pend
ent,
nona
cad-
emic
, am
bula
tory
, pri-
mar
y ca
re m
edic
alpr
actic
e of
65
phys
i-ci
ans
Dru
g co
sts
per
patie
nt p
er y
ear
incr
ease
d 1.
7% v
ersu
s na
tiona
lin
crea
se o
f 31.
2%. P
resc
riptio
ns p
erpa
tient
per
yea
r in
crea
sed
4% v
ersu
sun
chan
ged
natio
nal r
ate.
Cos
t pe
rpr
escr
iptio
n de
crea
sed
2.1%
ver
sus
natio
nal i
ncre
ase
of 3
1.2%
. Res
ults
due
to in
crea
se in
use
of g
ener
ics.
Net
med
ical
gro
updr
ug c
ost
per
enro
lled
mem
ber
per
year
ove
r2-
year
per
iod
Wei
nber
ger M
, Mur
ray
M,
Mar
rero
D, B
rew
er N
, Lyk
ens
M, H
arris
LE,
Ses
hadr
i R,
Caf
frey
H, R
oesn
er J
F, S
mith
F,
New
ell A
J, C
ollin
s JC
, McD
on-
ald C
J, T
iern
ey W
M. (
2002
).Ef
fect
iven
ess o
f pha
rmac
ist c
are
for p
atie
nts w
ith re
activ
e air
way
sdi
seas
e. J
AM
A, 2
88: 1
594–
1602
.
Ran
dom
ized
cont
rolle
d tr
ial
1,11
3 pa
rtic
ipan
ts w
ithac
tive
CO
PD o
r as
th-
ma.
Out
com
es w
ere
asse
ssed
in 9
47 (
85.1
%)
part
icip
ants
at
6m
onth
s an
d 89
8(8
0.7%
) at
12
mon
ths.
At
12 m
onth
s, p
atie
nts
rece
ivin
gph
arm
aceu
tical
car
e ha
d sig
nific
antly
high
er p
eak
flow
rat
es t
han
the
usua
l car
e gr
oup
(P =
.02)
but
not
than
PE
FR m
onito
ring
cont
rols
(P=
.28)
. No
signi
fican
t be
twee
n-gr
oup
diff
eren
ces
occu
rred
in m
ed-
Peak
exp
irato
ry fl
owra
tes,
bre
athi
ng-r
elat
edE
D o
r ho
spita
l visi
ts,
heal
th-r
elat
ed q
ualit
y of
life
(HR
QO
L),
med
ica-
tion
com
plia
nce,
and
patie
nt s
atisf
actio
n.
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
cont
inue
d
18
S O U N D M E D I C A T I O N T H E R A P Y M A N A G E M E N T P R O G R A M S
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Wei
nber
ger
M, M
urra
y M
,M
arre
ro D
, Bre
wer
N, L
yken
sM
, Har
ris L
E, S
esha
dri R
,C
affr
ey H
, Roe
sner
JF,
Sm
ithF,
New
ell A
J, C
ollin
s JC
,M
cDon
ald
CJ,
Tie
rney
WM
.(2
002)
.
icat
ion
com
plia
nce
or H
RQ
OL
.A
sthm
a pa
tient
s re
ceiv
ing
phar
ma-
ceut
ical
car
e ha
d sig
nific
antly
mor
ebr
eath
ing-
rela
ted
ED
or
hosp
ital
visit
s th
an t
he u
sual
car
e gr
oup
(OR
, 2.1
6; 9
5% C
I, 1
.76-
2.63
; P <
.001
). P
atie
nts
rece
ivin
g ph
arm
a-ce
utic
al c
are
wer
e m
ore
satis
fied
with
the
ir ph
arm
acist
tha
n th
e us
ual
care
gro
up (
P =
.03)
and
the
PE
FRm
onito
ring
grou
p (P
= .0
01)
and
wer
e m
ore
satis
fied
with
the
ir he
alth
care
tha
n th
e us
ual c
are
grou
p at
6m
onth
s on
ly (
P =
.01)
. Des
pite
ampl
e op
port
uniti
es t
o im
plem
ent
the
prog
ram
, pha
rmac
ists
acce
ssed
patie
nt-s
peci
fic d
ata
only
abo
ut h
alf
of t
he t
ime
and
docu
men
ted
actio
nsab
out
half
of t
he t
ime
that
rec
ords
wer
e ac
cess
ed.
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
19
2 0 0 6 C O N S E N S U S D O C U M E N T — A P P E N D I X B
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Goo
de J
K, S
wig
er K
, Blu
ml
BM
. (M
ar/
Apr
200
4).
Reg
iona
l ost
eopo
rosis
scr
een-
ing,
ref
erra
l, an
d m
onito
ring
prog
ram
in c
omm
unity
pha
r-m
acie
s: F
indi
ngs
from
Pro
ject
ImPA
CT
: Ost
eopo
rosis
. J A
mPh
arm
Ass
oc, 4
4(2)
:15
2–16
0.
Sing
le c
ohor
tob
serv
atio
nal
stud
y
Con
sum
ers
with
one
or
mor
e kn
own
risk
fac-
tors
for
oste
opor
osis
The
pha
rmac
ists
scre
ened
532
patie
nts
and
wer
e ab
le t
o co
ntac
t 30
5of
the
se p
atie
nts
for
follo
w-u
p in
ter-
view
s 3
mon
ths
to 6
mon
ths
late
r.T
he s
trat
ifica
tion
for
risk
of fr
actu
rew
as 3
7%, h
igh
risk;
33%
, mod
erat
eris
k; a
nd 3
0%, l
ow r
isk. A
tot
al o
f78
% o
f pat
ient
s in
dica
ted
that
the
yha
d no
prio
r kn
owle
dge
of t
heir
risk
for
futu
re fr
actu
re. I
n th
e m
oder
ate-
and
high
-risk
cat
egor
ies,
37%
of
patie
nts
sche
dule
d an
d co
mpl
eted
aph
ysic
ian
visit
, 19%
had
a d
iagn
ostic
scan
, and
24%
of t
hose
pat
ient
s w
ere
initi
ated
on
oste
opor
osis
ther
apy
sub-
sequ
ent
to t
he s
cree
ning
.Pa
rtic
ipat
ing
phar
mac
ies
rece
ived
paym
ent
for
both
the
ost
eopo
rosis
scre
enin
g an
d th
e co
llabo
rativ
e he
alth
man
agem
ent
serv
ices
.
Res
ults
of s
cree
ning
s,re
spon
ses
of p
atie
nts
and
phys
icia
ns t
o no
ti-fic
atio
ns, a
nd lo
ng-
term
res
ults
dur
ing
col-
labo
rativ
e ca
re
Han
lon
JT, A
rtz
MB,
Pie
per C
F,Li
ndbl
ad C
I, Sl
oane
RJ,
Rub
yC
M, S
chna
der K
E. (2
004)
.In
appr
opria
te m
edica
tion
use
amon
g fra
il el
derly
inpa
tient
s.A
nn P
harm
acot
her,
38(1
): 9–
14.
Obs
erva
tiona
l39
7 fr
ail,
elde
rly in
pa-
tient
s in
ele
ven
VA
faci
litie
s
Thr
ee h
undr
ed s
ixty
-fiv
e (9
1.9%
)pa
tient
s ha
d =1
med
icat
ion
with
=1
MA
I cr
iteria
rat
ed a
s in
appr
opria
te.
The
mos
t co
mm
on p
robl
ems
invo
lved
exp
ensiv
e dr
ugs
(70.
0%),
Prev
alen
ce o
f ina
ppro
-pr
iate
pre
scrib
ing
for
hosp
italiz
ed fr
ail,
elde
r-ly
pat
ient
s
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
cont
inue
d
20
S O U N D M E D I C A T I O N T H E R A P Y M A N A G E M E N T P R O G R A M S
App
endi
x B
: Evi
denc
e of
the
Pha
rmac
ists
’ Val
ue
Han
lon
JT, A
rtz
MB,
Pie
per C
F,Li
ndbl
ad C
I, Sl
oane
RJ,
Rub
yC
M, S
chna
der K
E. (2
004)
.
CI
= co
nfid
ence
inte
rval
; CO
PD =
chr
onic
obs
truc
tive
pul
mon
ary
dise
ase;
DR
R =
dru
g re
gim
en r
evie
w; E
D =
em
erge
ncy
depa
rtm
ent;
FDA
= F
ood
and
Dru
g A
dmin
istra
tion
; MA
I =
Med
icat
ion
App
ropr
iate
ness
Inde
x; N
CE
P =
Nat
iona
l Cho
leste
rol E
duca
tion
Pro
gram
; O
R =
odd
s rat
io; P
EFR
= p
eak
expi
rato
ry fl
ow r
ate.
impr
actic
al d
irec
tions
(55
.2%
), a
ndin
corr
ect
dosa
ges
(50.
9%).
The
mos
t co
mm
on d
rug
clas
ses
with
appr
opria
tene
ss p
robl
ems
wer
e ga
s-tr
ic (
50.6
%),
car
diov
ascu
lar
(47.
6%),
and
cent
ral n
ervo
us s
yste
m (
23.9
%).
The
mea
n ±
SD M
AI
scor
e pe
r pe
r-so
n w
as 8
.9 ±
7.6.
Ste
pwise
ord
inal
logi
stic
reg
ress
ion
anal
yses
rev
eale
dth
at b
oth
the
num
ber
of p
resc
rip-
tion
(adj
uste
d O
R, 1
.28;
95%
CI,
1.21
-1.3
6) a
nd n
on-p
resc
riptio
ndr
ugs
(adj
uste
d O
R, 1
.17;
95%
CI,
1.06
-1.2
9) w
ere
rela
ted
to h
ighe
rM
AI
scor
es. A
naly
ses
excl
udin
g th
enu
mbe
r of
dru
gs r
evea
led
that
the
Cha
rlson
inde
x (a
djus
ted
OR
, 1.6
2;95
% C
I, 1
.12-
2.35
) an
d fa
ir/po
orse
lf-ra
ted
heal
th (
adju
sted
OR
,1.
15; 9
5% C
I, 1
.05-
1.26
) w
ere
rela
ted
to h
ighe
r M
AI
scor
es.
Cit
atio
nSa
mpl
e Po
pula
tion
Stud
y T
ype
Res
ults
(Con
clus
ions
)O
utco
me
Vari
able
s
21
2 0 0 6 C O N S E N S U S D O C U M E N T — A P P E N D I X C
Appendix CGlossary
Access A patient’s ability to obtain medical care determined by the availability of medical servic-es, their acceptability to the patient, the location of health care facilities, transportation, hours ofoperation and cost of care.
Adherent; adherence Also referred to as compliance. The ability of a patient to take a med-ication or follow a treatment protocol according to the directions for which it was prescribed; apatient taking the prescribed dose of medication at the prescribed frequency for the prescribedlength of time.
Adverse event Any harm a patient suffers that is caused by factors other than the patient’sunderlying condition.
Best practices Actual practices, in use by qualified providers following the latest treatmentmodalities, which produce the best measurable results on a given dimension.
Case management A collaborative process of assessment, planning, facilitation and advocacyfor options and services to meet an individual’s health needs through communication and avail-able resources to promote quality cost-effective outcomes.
Centers for Medicare and Medicaid Services (CMS) Formerly known as the HealthCare Financing Administration (HCFA), the federal agency responsible for administeringMedicare and overseeing states’ administration of Medicaid and the State Children’s HealthInsurance Program.
Drug utilization review (DUR) A system of drug use review that can detect potential adversedrug interactions, drug-pregnancy conflicts, therapeutic duplication, drug-age conflicts, etc.There are three forms of DUR: prospective (before dispensing), concurrent (at the time of pre-scription dispensing) and retrospective (after the therapy has been completed). Appropriate use ofan integrated DUR program can curb drug misuse and abuse and monitor quality of care. DURcan reduce hospitalization and other costs related to inappropriate drug use.
Medicare Advantage plans (MA-PDs) Health plan coverage that is offered under a man-aged care policy or plan that has been approved by CMS and provides both prescription drug andcomprehensive health care coverage.
Medicare Modernization Act (MMA) The Medicare Prescription Drug, Improvement, andModernization Act of 2003, referred to as the Medicare Modernization Act, was enacted inDecember 2003. Title I of MMA established a new Part D of Medicare, which provides anoptional outpatient prescription drug benefit effective January 2006.
Prescription drug plan (PDP) Medicare Part D prescription drug coverage that is offeredunder a policy or plan that has been approved by CMS and is offered by a PDP sponsor that hasa contract with CMS.
Self-insured employers Employers who choose to accept the financial risk for the health carecosts of their employees. Typically, employers “hire” a health plan or insurance company to pro-vide for the health care needs of their employees (and often their family members), and theemployers accept the financial risk for the services provided. This allows employers to retain sav-ings if the costs of health care provided are effectively managed. Self-insured employers will use ahealth plan or insurance company to provide administrative services such as claims processing.Self-insured employers commonly purchase stop-loss insurance to cover catastrophic cases.
22
S O U N D M E D I C A T I O N T H E R A P Y M A N A G E M E N T P R O G R A M S
Appendix DConsensus Document Work Group Participants:
AARPN. Lee Rucker, MSPHSenior Policy AdvisorPublic Policy Institute
Academy of Managed Care PharmacyJudith A. Cahill, CEBSExecutive Director
American Academy of Family PhysiciansDonnie Batie, MDPhysician in private practice
American Geriatrics SocietySunny A. Linnebur, PharmD, FASCP, BCPS, CGPHealth Care Systems Committee MemberAssistant Professor, Department of Clinical PharmacyUniversity of Colorado Health Sciences Center
American Pharmacists AssociationAnne Burns, RPhGroup Director, Practice Development and Research
American Society of ConsultantPharmacistsCarla Saxton, RPh, CGPAssistant Director, Policy and Advocacy
Case Management Society of AmericaJeanne Boling, MSN, CRRN, CDMS, CCMAssociate Executive Director
Department of Veterans AffairsVirginia Torrise, PharmDDeputy Chief ConsultantPharmacy Benefits Management SHG
National Business Coalition on HealthAndrew WebberPresident and CEO
23
2 0 0 6 C O N S E N S U S D O C U M E N T — A P P E N D I X D
Resource Group:15 health plans, pharmacy benefit management companies, integrated health care systemsand medication therapy management programs, including:
Community Care Rx
Coventry Health Care, Inc.
Humana
Independent Health
Intermountain Health Care
Kaiser Permanente
Medicine Shoppe International
Outcomes Pharmaceutical Health Care
Ovations: Pharmacy Solutions, UnitedHealth Group
Premier Pharmacists Network
Prescription Solutions
Scott & White Health Plan
Walgreens Health Initiatives
Pharmacy Organizations Serving as Reviewers:
American Association of Colleges of Pharmacy
American Society of Health-System Pharmacists
College of Psychiatric and Neurologic Pharmacists
National Association of Chain Drug Stores
24
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This project and the printing of this document was funded through a restricted grant from Merck/Schering-Plough (MSP).