- Medication therapy management
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Medication therapy management Intervention ICD-10-PCS GZ3 Medication therapy management (MTM) is a partnership of the pharmacist, the patient or their caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy.[1] MTM was first proposed by Ronald Jordan, former APhA president.[2] MTM includes the analytical, consultative, educational and monitoring services provided by pharmacists to help consumers get the best results from medications through enhancing consumer understanding of medication therapy, increasing consumer adherence to medications, controlling costs, and preventing drug complications, conflicts, and interactions. This is the side of pharmacy giving value to cognitive services and removing the pharmacist from a solely distributive function. There are many topics/disease states that can be improved by MTM, including, but not limited to Diabetes, Asthma, and Elderly Care.[3]
A clinical pharmacist will typically provide medication therapy management services through review of a list of medications the patient provides. The things the pharmacist will be looking at include drug interactions, duplications of drugs from the same family, doses, routes of administration, and the formulation the patient is using. This review will also include evaluating medication habits to see where we may be able to optimize the benefit a patient receive.[4]
Medication Therapy Management was coined by Congress in the Medicare Modernization Act of 2003 (MMA 2003). The MMA 2003 established the requirement that each Medicare Part D plan sponsor offer a Medication Therapy Management program to targeted beneficiaries beginning in 2006.[5] At a minimum, targeted beneficiaries include those members with multiple chronic conditions, taking multiple Part D drugs, and likely to incur annual costs for covered Part D drugs that exceed a predetermined level. While plan sponsors are required to offer MTM to these targeted beneficiaries, other patients can also benefit from MTM and many plans have employed MTM programs as a proactive strategy to prevent medication-related complications and associated health care costs by extending the MTM benefit to their full population of members. It is important to also note that MTM may apply to populations outside of Medicare, including patients less than 65 years of age.[6]
The provision of MTM services requires pharmacists to collaborate with both patients and prescribers to resolve medication-related complications. According to guidance set forth by the Centers for Medicare and Medicaid Services (CMS), each MTM-eligible patient should be covered for an annual Comprehensive Medication Review (CMR), inclusive of an interactive, person-to-person consultation. In addition to the annual Comprehensive Medication Review, quarterly targeted medication reviews are also required.[7] Appropriate MTM services should also be provided on an ad hoc basis as medication-related complications are identified.
Medicare Part D plans are required to measure and report MTM program outcomes to CMS. MTM-specific CPT codes have been established for use by pharmacists when billing for MTM services and while CPT codes offer a standard method of billing they are not descriptive in nature.[8] CMS currently requires programs to report information beyond what is captured via a CPT code regarding the MTM services provided to patients, and it is anticipated even more detailed reporting will be required in the future. As a result of this gap between the standardized billing codes and plan reporting requirements, several proprietary software platforms are available in the marketplace. These platforms allow pharmacists to document specific details of the MTM services delivered, including drug therapy problems identified, intervention results, severity ratings, and progress notes. This information is utilized by program sponsors to track individual patient outcomes, monitor return-on-investment and fulfill CMS reporting requirements.
For more information regarding Medication Therapy Management, please reference:
- Barnett, M, Frank, J, Wehring, H et al. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm. 2009;15(1):18-31.
- Core Elements of an MTM Service Model Version 2.0. Published March 2008.
- Medication Therapy Management Services Definition and Program Criteria. Approved July 27, 2004.
- The Lewin Group. Medication therapy management services: a critical review. J Am Pharm Assoc. 2005;45(5):580-7.
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