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MEDICATION THERAPY MANAGEMENT SERVICES

The Illinois Council of Health-System Pharmacists (ICHP) supports the consensus definition of Medication Therapy Management as presented by the group of 11 national pharmacy organizations in July 2004.

“Medication Therapy Management is a distinct service or group of services that optimize therapeutic outcomes for individual patients.  Medication Therapy Management Services are independent of, but can occur in conjunction with, the provision of a medication product.

Medication Therapy Management encompasses a broad range of professional activities and responsibilities within the licensed pharmacist’s, or other qualified health care provider’s, scope of practice.  These services include but are not limited to the following, according to the individual needs of the patient:

  1. Performing or obtaining necessary assessments of the patient’s health status;
  2. Formulating a medication treatment plan
  3. Selecting, initiating, modifying, or administering medication therapy;
  4. Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness
  5. Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events;
  6. Documenting the care delivered and communicating essential information to the patient’s other primary care providers;
  7. Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications;
  8. Providing information, support services and resources designed to enhance patient adherence with his/her therapeutic regimens;
  9. Coordinating and integrating medication therapy management services within the broader health care-management services being provided to the patient.

A program that provides coverage for Medication Therapy Management services shall include:

  1. Patient-specific and individualized services or sets of services provided directly by a pharmacist to the patient.* These services are distinct from formulary development and use, generalized patient education and information activities, and other population-focused quality assurance measures for medication use.
  2. Face-to-face interaction between the patient* and the pharmacist as the preferred method of delivery.  When patient-specific barriers to face-to-face communication exist, patients shall have equal access to appropriate alternative delivery methods.  MTM programs shall include structures supporting the establishment and maintenance of the patient*-pharmacist relationship.
  3. Opportunities for pharmacists and other qualified healthcare providers to identify patients who should receive medication therapy management services.
  4. Payment for Medication Therapy Management Services consistent with contemporary provider payment rates that are based on the time, clinical intensity, and resources required to provide services (e.g., Medicare Part A and/or Part B for CPT & RBRVS).
  5. Processes to improve continuity of care, outcomes, and outcome measures.

*In some situations, Medication Therapy Management Services may be provided to the caregiver or other persons involved in the care of the patient.”

The MTM service model in pharmacy practice includes the following core elements:

  • Medication therapy review (MTR)
  • Personal medication record (PMR)
  • Medication-related action plan (MAP)
  • Intervention and/or referral
  • Documentation and follow-up

These five core elements form a framework for the delivery of MTM services in pharmacy practice. Requirements for Medication Therapy Management Programs (MTMP) under 423.153(d), a Part D sponsor are found at:
https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.html

ICHP supports implementation and continued monitoring of these requirements to determine what further improvements may be made to Medicare Part D and healthcare for all patients.  ICHP firmly believes that State and National pharmacy associations have an obligation to work with legislators and regulators to ensure safe and appropriate medication therapy.
In 2010, the office of CMS clearly defined new requirements for the MTM services provided through the Medicare Prescription Drug Improvement and Modernization Act of 2003.  The requirements constitute a strong foundation for the services that every patient, not only Medicare Part D recipients, should receive.
    
http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf

Revised 09/2016