Medication Therapy Management
When one thinks of the Medicare Part D prescription benefit, first thoughts are of this program providing medications to millions of Medicare beneficiaries and also of the hubbub and problems that surrounded the first couple of months of implementation. However, in addition to providing payment assistance for medications, Medicare Part D also requires that the prescription drug plans (PDPs) to address issues related to medication safety and quality of care. Medication Therapy Management (MTM) is one element designed to improve safety and quality.
What is a MTM service?
MTM programs are fundamentally a quality improvement component of the Medicare Part D benefit with the potential to favorably impact the clinical, humanistic and economic outcomes achieved through improved medication use. MTM encompasses a broad range of professional activities and responsibilities within the pharmacist's or other qualified health care provider's scope of practice. According to the individual needs of the patient, these services include, but are not limited to, the following:
- Providing verbal education and training designed to enhance the patient's understanding and appropriate use of his/her medication;
- Providing information, support services and resources designed to enhance the patient's adherence to his/her therapeutic regimens;
- Evaluating therapeutic regimens in terms of formulary and cost-effectiveness for the patient;
- Performing a comprehensive medication review to identify, resolve and prevent medication-related problems, including adverse drug events;
- Documenting the care delivered and communicating essential information to the patient's other primary care providers;
- Formulating a medication treatment plan;
- Coordinating and integrating medication therapy management services within the broader health care management services being provided to the patient;
- Monitoring and evaluating the patient's response to therapy, including safety and effectiveness;
- Performing or obtaining necessary assessments of the patient's health status.
How are MTM programs delivered?
There are currently two consensus documents that have been developed by numerous health care professional associations in an attempt to standardize the implementation of MTM services. Despite these two consensus documents, there is currently insufficient empirical evidence about which type of MTM programs work well in mainstream practice settings. As a result, it is difficult for the Centers for Medicare & Medicaid Services (CMS) to set standards and requirements for the contracted drug plans as they implement and design their respective MTM programs. Because the MTM program is currently loosely defined and left largely to the prescription drug plans (PDPs) and Medicare Advantage drug plans (MA-PDs) for service design, a variety of delivery methods are expected. It is expected that a majority of MTM services are most likely to be delivered by:
- Personalized mailings of clinical/educational messages to the beneficiaries;
- Telephonic interactions with a qualified health care provider;
- Face-to-face interventions with a trained pharmacist or other qualified health care provider.
Which patients will qualify and who will pay for delivery of MTM services?
These services are targeted at patients with the greatest risk for experiencing adverse medication outcomes. Once again CMS allowed the PDPs and MA-PDs to identify their at-risk population within some very general criteria:
- Patients must be expected to spend at least $4,000 a year on Part D medications;
- Patient must have multiple chronic diseases;
- Patients must take multiple chronic medications.
Given these general criteria, plans are left to define which and how many chronic disease patients must have to qualify for MTM and how many medications they take. Some plans have specified that patients must be diagnosed with certain disease states (diabetes, heart disease, asthma, COPD, hypercholesterolemia, etc.) AND take a minimum number of medications (at least 6 or 8, etc.).
The good news is that MTM services come at no additional cost to the patient. PDPs and MA-PDs must provide services to all qualified patients within the cost of the benefit plan premium.
Although most providers (physicians, advanced practice nurses, physician assistants) may not be directly involved in MTM services, their awareness of the availability and value of the MTM programs are essential for the adoption and success of these programs. The MTM programs may provide a solution for overworked providers practicing in busy clinical settings by sharing some of the responsibilities of complex drug therapy management with the drug experts in their community. We all look forward to the prospects of improved drug therapy management that can best be provided using an interdisciplinary, team-based approach.