Presentation on theme: "Medication Therapy Management"— Presentation transcript:
1 Medication Therapy Management LT Scott Raisor, PharmDIndian Health Service, Phoenix Area,Colorado River Service UnitMedication Therapy Management
2 Legacy of Innovation in IHS 1962: Shift from distribution to clinical services1969: Pharmacists provide direct patient care as primary care providers
3 Legacy of Innovation in IHS 1996: RADM Michael Trujillo codifies Pharmacists as Primary Care Providers (PCPs) with prescriptive authority1997: National Clinical Pharmacy Specialist (NCPS) certification established2011: PHS Pharmacy Report to the Surgeon General and the Surgeon General’s Support Letter
4 Justification for Expanding Services “Advance beyond discussion of the value of expanded roles of pharmacists and move towards health system support and implementation of these roles.”1.5 billion preventable medication related problems occur each yearThe United States health care system spends over $177 billion dollars annually on medication related problems
5 What is Medication Therapy Management? Medication Therapy Management services are patient centered assessment and evaluation of the patient’s full medication regimen and not only individual medicationsGoals:Optimize medication useImprove collaborationEnhance communicationEmpower patients
6 What is Medication Therapy Management? MTM is separate and distinct from pharmacist managed disease state clinicsPharmacist managed clinics require and provide a higher level of care
7 What is Medication Therapy Management? Medicare Part D sponsors are required to provide MTM services to their patients42 CFR (d)
8 42 CFR (d)(d)Medication therapy management program (MTMP)— (1) General rule. A Part D sponsor must have established a MTMP that—(i) Is designed to ensure that covered Part D drugs prescribed to targeted beneficiaries described in paragraph (d)(2) of this section are appropriately used to optimize therapeutic outcomes through improved medication use;(ii) Is designed to reduce the risk of adverse events, including adverse drug interactions, for targeted beneficiaries described in paragraph (d)(2) of this section;(iii) May be furnished by a pharmacist or other qualified provider; and(iv) May distinguish between services in ambulatory and institutional settings.(v) Must enroll targeted beneficiaries using an opt-out method of enrollment only.(vi) Must target beneficiaries for enrollment in the MTMP at least quarterly during each plan year.(vii) Must offer a minimum level of medication therapy management services for each beneficiary enrolled in the MTMP that includes all of the following:(A) Interventions for both beneficiaries and prescribers.(B) Annual comprehensive medication review with written summaries. The comprehensive medication review must include an interactive, person-to-person, or telehealth consultation performed by a pharmacist or other qualified provider unless the beneficiary is in a long-term care setting and may result in a recommended medication action plan.(C) Quarterly targeted medication reviews with follow-up interventions when necessary.(D) Standardized action plans and summaries that comply with requirements as specified by CMS for the standardized format.
9 Who is Eligible? Medicare criteria Medicaid Private plans Employers Multiple chronic disease statesMultiple medicationsHigh drug costsMedicaidFlorida, Iowa, Maryland, Minnesota, Missouri, Mississippi, Ohio, VirginiaPrivate plansEmployersSelf-pay
10 Medicare Eligibility Chronic disease states CMS requires 3 or lessSponsors must include the 7 core chronic diseasesDiabetesHypertensionDyslipidemiaHeart failureRespiratory diseaseBone diseaseMental health disorder2011 Medicare Part D Medication Therapy Management (MTM) Programs. Fact Sheet. Available at Accessed on May 16th, 2012
11 Medicare Eligibility Multiple medications High drug costs CMS requires 8 or lessHigh drug costs$3,000 or higher in annual medication costsAverage $250 per month2011 Medicare Part D Medication Therapy Management (MTM) Programs. Fact Sheet. Available at Accessed on May 16th, 2012
12 MTM Best PracticesCMS regulations established a general framework that allows for best practices10 pharmacy organizations collaborated to develop the core elements of an MTM visitAPhA/NACDS Foundation: Medication Therapy Management in Community Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008.
13 Five Key Elements Medication Therapy Review (MTR) “is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them”Personal Medication Record (PMR)“is a comprehensive record of the patient’s medications”Medication-Related Action Plan (MAP)“is a patient-centric document containing a list of actions for the patient to use in tracking progress for self-management”Interventions or Referrals“The pharmacist provides consultative services and intervenes to address medication-related problems; when necessary, the pharmacist refers the patient to a physician or other healthcare professional”Documentation and Follow Up“MTM services are documented in a consistent manner, and a follow-up MTM visit is scheduled based on the patient’s medication-related needs, or the patient is transitioned from one care setting to another”APhA/NACDS Foundation: Medication Therapy Management in Community Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008.
14 Best Practice Flow Chart APhA/NACDS Foundation: Medication Therapy Management in Community Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008.
15 MTM ServicesMedicare sponsors must provide a minimum level of MTM servicesComprehensive Medication Review (CMR)AnnuallyTargeted Medication Review (TMR)Quarterly
16 Comprehensive Medication Review (CMR) Comprehensive annual review of all medicationsInteractive person to personPhone callPharmacy visitAffordable Care Act standardizes the content and format of the CMR starting January 1, 2013ComponentsCover LetterMedication Action PlanPersonal Medication List
17 Targeted Medication Review (TMR) TMR must be provided at least quarterlyTMR is meant to address specific or potential medication-related problemsDoes not have to be face-to-face
18 Who can provide MTM services? PharmacistsOnly provider specifically mentionedRegistered NursesPhysiciansNon-physician providers2011 Medicare Part D Medication Therapy Management (MTM) Programs. Fact Sheet. Available at Accessed on May 16th, 2012
19 IHS Pharmacy Electronic Health Record (EHR) IHS mode of counseling Allows for comprehensive reviewsPhysician notes, lab work, and medication listsIHS mode of counselingNewThree prime questionsRefillShow and tellOpen dialogue about disease not just medicine
20 10 Steps to Your Medications: Why the Wait? Five Key Elements to an MTM visit:Medication Therapy Review (MTR)Personal Medication Record (PMR)Medication-related Action Plan (MAP)Intervention or referralDocumentation and Follow Up1. After your appointment, the doctor enters your prescription into the computer2. The pharmacy receives the order signed by the doctor3. The pharmacist checks the prescription for errors4. The pharmacist looks at your lab results5. The pharmacist reviews your chart for drug interactions and allergies6. The pharmacist may call your doctor for questions7. The medications are counted and packaged8. The pharmacist does a final check for safety and accuracy9. The pharmacist counsels you on your medications10. You receive your medications and can ask any questions you haveDocumentMTRReview EHRDocumentMAPInterventionDocumentPMRMedication List
21 Best Practice Flow Chart IHS Prescription Processing ChartMeds ordered in EHRMeds dispensed and patient counseledAPhA/NACDS Foundation: Medication Therapy Management in Community Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008.
22 IHS is Leading AgainOur legacy of innovation has allowed PHS pharmacists to lead the professionProviding clinical services since 1962We are already providing MTM for our patientsPotential reimbursement opportunities?
24 Part D Prescriptions Filled in 3 months Number of PrescriptionsMedicare Part D Plans
25 Part D ReimbursementThe largest Part D provider does not allow for reimbursement to community pharmacists for MTM servicesThe second largest provider only has four patients who qualify for MTM reimbursable services
26 Part D reimbursementPart D sponsors determine payments for MTM servicesConsidered administrative costs80% allow external personnel31% use vendors25% use community pharmacistsPlans require contracts with pharmaciesSeparate from medication dispensingThere is not much published on reimbursement Limited to vendor’s published numbers
27 MTM Vendors MirixaPro® MirixaEdge® Outcomes® Others: Mirixa.com No cost for participationMirixaEdge®PayProvides documentation to submit to non-contracted part D plans or for out of pocket billingOutcomes®Getoutcomes.comNo cost for participationOthers:PharmMD®Pharmmd.comEmploy pharmacistsCan make $2,000/month
30 Is MTM the future of pharmacy? Providing MTM services improves outcomesReimbursement for pharmacist-delivered patient care is a step forward, BUT:Part D pays the pharmacy not the pharmacistPharmacists are not the only providersRight now, MTM does not look to preventionEligible patients are already a burden on health system
31 Pharmacists are Patient Care Providers “Pharmacist-delivered patient care services fit most definitions of “primary care” services (with the exception of diagnosis) as defined by major medical and health organizations”“Compensation … should reflect the level of care provided”Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.
32 MTM ConclusionPotential reimbursement for actions that PHS pharmacists engage in currentlyCreate time to make appointments, proper documentation, and provide opportunities for reimbursement and reportingWork with TribesProvide presentations on correct medication habitsMTM should not prevent PHS pharmacists from continually leading with new and innovative patient care practices
33 CitationsAPhA/NACDS Foundation: Medication Therapy Management in Community Pharmacy Practice: Core Elements of an MTM Service Model. Version 2.0. March 2008.Lee MP, Giberson S. Implementation of the Indian Health Service National Clinical Pharmacy Specialists (NCPS) Program. Available at Accesses May 16th, 2012.2011 Medicare Part D Medication Therapy Management (MTM) Programs. Fact Sheet. Available at Accessed on May 16th, 2012.Giberson S, Yoder S, Lee MP. Improving Patient and Health System Outcomes through Advanced Pharmacy Practice. A Report to the U.S. Surgeon General. Office of the Chief Pharmacist. U.S. Public Health Service. Dec 2011.Schupbach R. Insights from the bizarre perspective and mind of Ryan Schupbach. Presented at the Oklahoma Area IHS Pharmacy Chief’s Meeting, February 17th, 2012.
34 QuestionsLT Scott Raisor Colorado River Service Unit Agency Road Parker, AZ