PSTAC

1. PSTAC Pharmacist Services Technical Advisory Coalition

2. Origins of Medication Therapy Management • Federal legislation of the 1990’s • Medicare Payment Advisory Commission report of 2002 • Archives of Internal Medicine (Aug. 2003) • Pharmacy consensus statement of 2004

3. MTM Consensus Definition “MTM is a distinct service or group of services that optimize therapeutic outcomes for individual patients. MTM services are independent of, but can occur in conjunction with, the provision of a medication product.” Approved July 27, 2004 by AMCP, AACP, ACA, ACCP, ASCP, APhA, ASHP, NABP, NACDS, NCPA, and the NCSPAE.

4. MTM and Medicare Part D • MTM is a stipulation of Part D legislation • Part D Plans must have MTM program • May be provided by pharmacists

5. MTM and Medicare Part D • Plans must target high risk beneficiaries (at minimum) • Multiple chronic conditions • Multiple medications • High drug costs (>$4,000 in 2006) • Plans must reimburse providers for time and resources

6. Purpose of MTM • To optimize therapeutic outcomes • To decrease the likelihood of adverse events • To enhance patient understanding and adherence • To reduce overall healthcare spending

7. MTM Activities • Assess patients’ health status • Devise medication treatment plan • Select, modify and administer medications • Review current medications and identify drug-related problems • Communicate care to other providers • Provide patient education • Refer patients for broader disease management services

8. The MN-Medicaid MTM Law • Enacted July 2005 (12 yrs of legislation) • Service definition • Patient eligibility • Pharmacist eligibility • Place of service specifications • Private patient care area requirements • RBRVS billing framework using MTM CPT codes

9. MN-Medicaid MTM Compensation • 0115T: First encounter, face-to-face, first 15 minutes; $52.00 • 0116T: Follow-up encounter, same patient, first 15 minutes; $34.00 • 0117T: Additional increments of 15 min of time for 0115T or 0116T; $24.00

10. MTM: Managed Care Perspective • Over 95% of MCO enrollees have a Rx benefit • Many MTM services are part of SOP • Brown bag reviews for new enrollees • Drug utilization reviews • Coordination of medications among multiple prescribers • Warfarin Clinics – Pharmacists review pt medications and INR values to determine dosing • Total patient care

11. MTM: Managed Care Perspective • MTM is necessary piece of patient care • Reduce medication redundancy • Avoid harmful drug/drug interactions • Use edits within IT systems • Encourage adherence • MTM under Medicare • Necessary for vulnerable population • Aligns with MA-PD philosophy • PDPs have greater challenge