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 PHARMACIST and 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 MTM suggested by MMA 2003 Educate patient Increase adherence –Refill reminders –Packaging Detect side effects Detect overuse/underuse

10. Elements of MTM suggested 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/PrescriptionDrug CovContra/Downloads/2010CallLetter.pdf] January 7, 2003. Medicare Prescription Drug Improvement, and Modernization Act of 2003. p. 20-22