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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?.

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medication therapy management

Medication Therapy Management

Linda Mach, PharmD

Bartell Drugs

Community Practice Resident

February 26, 2010

objectives
Objectives
  • Define Medication Therapy Management (MTM)
  • Identify the essential components of MTM
  • Explain the importance of pharmacist involvement in MTM services
what is mtm
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
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 PHARMACISTand physician
    • Targeted towards specific patients
    • Must pay pharmacist for services!!!
targeted beneficiaries
“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
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
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
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
Elements of MTMsuggested 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
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
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
Providing MTM
  • Setting
    • Institutional
    • Ambulatory/community
  • Two types of MTM
    • Point-of-care
    • Comprehensive Medication Review
point of care
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
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
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
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
consultation1
Consultation
  • Other issues to assess
    • Patient’s healthcare priorities
      • Cost
      • Comfort
      • Convenience
      • Simplifying therapy
    • Language barriers
    • Literacy level
    • Cultural Issues
follow up
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
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
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
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