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KEY POINTS

KEY POINTS

  • Achieving high patient participation rates in medication therapy management (MTM) services for Medicare Part D plans has been challenging since the inception of MTM.

  • Patient barriers to participating in MTM services include lack of familiarity with what the services include and benefits of participation.

  • Health plans are measured on MTM comprehensive medication review (CMR) completion rate, so overcoming barriers to MTM provision is essential to improve patient participation.

  • Pharmacists often face barriers to providing MTM services, including compensation, time, staffing issues, and collaboration.

  • Key stressors in the current physician practice environment include dealing with increasing administrative burdens, integrating electronic health records into practice workflows, and downward pressures on physician income.

  • Payer value-based purchasing programs increasingly score physicians on clinical and efficiency metrics and tie reimbursement to those metrics.

  • Survey data indicate that physicians have an incomplete understanding of MTM programs.

  • Physicians respond most favorably to MTM services such as general patient medication education, identifying prescribing errors, assisting patients with obtaining refills, developing accurate medication lists, working to increase patient adherence, and detecting medication adverse effects. Physicians express concerns about MTM programs creating ambiguity about professional roles, imposing new and additional administrative or time burdens on physicians, and the sufficiency of pharmacist training for disease state education and specific medication recommendations. More high quality evidence is needed on the impact of MTM programs on ultimate health outcomes and cost reduction.

  • Key opportunities for pharmacists and physicians to work together in the MTM arena include supporting more research into MTM effectiveness, promoting innovations that integrate MTM services into electronic health records (EHRs), and establishing adequate reimbursement for MTM.

INTRODUCTION

Pharmacist-provided MTM is delivered in collaboration with physicians and other healthcare providers with the goal of optimizing therapeutic outcomes for individual patients. MTM services typically involve direct pharmacist-patient interaction and include an ala carte menu of discrete services including, but not limited to, the following:

  • Individual patient medication therapy review

  • Creating a personal medication record

  • Developing an individualized medication-related action plan

  • Recommending intervention and referral where appropriate

  • Documentation of services and arranging follow-up1

MTM programs were established in recognition of the critical role that safe and effective medication management plays in optimizing medical outcomes. To illustrate this point, note that more than 1.5 million preventable medication adverse events occur in the United States each year, resulting in an excess of $177 billion in health-related costs.2,3 And to highlight the potentially modifiable nature of this excess morbidity and cost, up to two-thirds of all medication-related hospital admissions are the result of medication nonadherence, which is clearly subject to improvement with intervention.4 The clear hope and intent is that MTM services will improve outcomes such as these.

Recognizing individual pharmacists as key participants in the patient’s health team, strategically positioned to assist with medication-related outcomes, has a long and venerable history. The creation of MTM ...

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