Medication Therapy Management

If ACOs are guided to improve patient outcomes and reduce costs (unnecessary readmissions, treatment complications, etc) the pharmacists’ provision of MTM is a vital component.

What is Medication Therapy Management?
MTM is an emerging, personalized appointment service provided by pharmacists that optimizes therapeutic outcomes for individual patients. These services may include (but are not limited to) medication review for drug interactions, drug duplication, costs/ incorporation of generics, communication and review with the primary care provider for recommended treatment adjustments; and personalized patient education to ensure proper use.

Why should ACOs incorporate MTM services into their care model?
Experts estimate that in the United States 1.5 MILLION preventable, adverse medication-related events occur each year that result in $177 BILLION in injury and death. (American Pharmacists Association)

What are the Benefits to the Patient?

One-on-one time allows the pharmacist to fully analyze patients’ current medication therapy, including OTC medications and vitamin/herbal supplements.
Patients gain valuable knowledge about their medication therapy and learn to take an active role in optimizing the success of their treatment.
Careful analysis of patients’ medication therapy allows the pharmacist to monitor for drug-drug, drug-disease, and drug-food interactions
Cost analyses are performed to ensure patients are treated in the most cost-effective way.
Dosing regimens are reviewed to increase dosing convenience (which could improve adherence)
Drug review can reduce patient discomfort and increase quality of life (patient satisfaction)

Who is Currently Eligible to Receive MTM Services?
MTM is a CMS provision requirement for some Medicare Part D recipients (Medicare’s Prescription Drug Plan) reimbursed by the Part D insurer. Certain patient criteria must be met for the service to kick in, and patients are notified that they are eligible. Patients can refuse the service (probably the ones who need it most). Some non-Part D Insurance providers cover MTM, but many do not.

Who benefits the MOST from an MTM program?

Patients with multiple providers and use multiple pharmacies (universal EMR would really help here, especially ones where patients could enter their OTC and herbal supplements they are taking).
Patients who require additional education about their medications (most of us)
Patients on multiple long term medications, or who have a chronic condition (asthma, CHF, diabetes, high blood pressure, elevated cholesterol, etc.)
Patients who require close monitoring (on anticoagulants, insulin)
Patients (and caregivers) in care transitions, especially after hospital discharge in their home or care facility environment. (Do they have their new meds, know how to take them, are they compatible with other medications and know dietary restrictions/interactions?)
Patients with a new prescription or a dosage change to their current treatment regimen.

After recent conversations with several pharmacists who currently provides MTM services, average cost for an MTM consult varies between $40.00 and $75.00 (good bang for the buck, cheaper than my monthly hair appointment, and far more economical than an emergency room admission) and can take up to an hour. Follow-up appointments run about $35.00. Anyone can request an MTM appointment and patients can contact their insurer to determine if the service is a covered benefit. Some companies offer the service via telephone (another potential growth area for telehealth). There are advanced MTM certification programs for pharmacists, but according to pharmacists I spoke with, all pharmacists have the knowledge to provide this type of service, but depending on the institution they are practicing in , time constraints and work flow may not allow for an appointment based, thorough review (Walgreens provides it, I asked).

Significant findings on this topic are that patients rarely request an MTM visit on their own. This, I believe, is because there is a lack of awareness of the availability and benefits of such a service and a huge lack of awareness of the potential for drug interactions, particularly with over-the-counter medications and herbal supplements. How about physicians start prescribing MTM to their patients when adding or changing prescriptions?

Post hospital discharge and any physical care transitions are a good place to initiate MTM services and the Patient Centered Medical Home (PCMH) platform is where it should live and dwell (a no-brainer).

I welcome any contributions you can make on your program or plans for MTM services in your organization.