Medication Therapy Management

1. Medication Therapy Management Linda Mach, PharmD Bartell Drugs Community Practice Resident February 26, 2010

2. Objectives • Define Medication Therapy Management (MTM) • Identify the essential components of MTM • Explain the importance of pharmacist involvement in MTM services

3. 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”

4. 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!!!

5. “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

6. 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

7. 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

8. 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

9. Elements of MTMsuggested by MMA 2003 • Educate patient • Increase adherence • Refill reminders • Packaging • Detect side effects • Detect overuse/underuse

10. 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

11. 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

12. Providing MTM • Setting • Institutional • Ambulatory/community • Two types of MTM • Point-of-care • Comprehensive Medication Review

13. 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)

14. 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

15. 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

16. 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

17. Consultation • Other issues to assess • Patient’s healthcare priorities • Cost • Comfort • Convenience • Simplifying therapy • Language barriers • Literacy level • Cultural Issues

18. 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

19. 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)

20. 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

21. 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