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Medication Ther..


Medication therapy management (MTM) services were enacted as part of the Medicare prescription benefit (Part D) with the Medicare Modernization Act (MMA) of 2003. Pharmacy celebrated this addition, as it was the first opportunity for pharmacists to be directly compensated for a patient-related service. Concerns arose however as practitioners learned more about the definition of MTM per MMA of 2003 and observed the design and implementation of MTM services through Part D programs. To assist with successful implementation, the American Pharmacist Association and National Association of Chain Drug Stores published a document in 2005 that defined the “core elements” of a MTM service in a community pharmacy.1 This document introduced us to the comprehensive medication review (CMR), targeted medication review (TMR), medication action plan (MAP), and personal medication record (PMR).1 In 2008, the updated 2.0 version of these elements was published with hopes to improve the provision of MTM services, continuity of care and patient outcomes.2 Despite this guidance, pharmacists have identified several issues surrounding the landscape of MTM programs. With the initial implementation of MTM, Part D programs were given significant freedom to design their individual MTM process and compensation mechanism as long as they followed the guidelines provided by the Center of Medicare and Medicaid Services (CMS). As a result MTM programs varied widely leading to potential issues for implementation of clinical services by pharmacists. Pharmacists identified differing patient enrollment criteria to identify “high risk beneficiaries” between Part D plans, an inability to offer services to individuals identified outside of the Part D program’s process, a lack of standardization of the MTM design and process, and no defined or consistent compensation mechanism.


A survey of MTM programs from 2005-06 confirmed that MTM services differed among the various Part D programs. The “core elements” of MTM services hope to empower patients to take an active role in their medication management, so it is positive that most programs offered patient education (75%). Surprisingly, however, in a program where the service is intended to optimize medication use just 60% of programs offered a medication review. The most common method of delivering MTM was mailed information with 90.4% of programs using in-house call centers. The frequency of the service for eligible individuals varied from monthly (14.3%) to annually (14.3%) with some not having a regular schedule. Lastly, most of the MTM services did involve a pharmacist (95.2%) who was employed or contracted for MTM.3 Since that early survey, thankfully several of the findings have improved. Information provided from Part D programs in 2011 to CMS indicated that 96% of plans use pharmacists to provide the service and all programs now offer to complete a medication review at least over the phone. Follow-up has improved and MTM programs must target individuals on an established schedule, at least quarterly. Additionally, a minimum level of MTM services that must be provided has been established. Eligible individuals must be offered an interactive comprehensive medication review (CMR) and the ...

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