Post on 05-Jan-2016
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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?
• 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