OVERVIEW OF PHARMACIST-LED MEDICATION THERAPY MANAGEMENT
AMANDA MAYER, PharmD
Amanda Mayer is a graduate of the University of Montana, Skaggs School of Pharmacy. She has clinical experience working in inpatient mental health, which is her passion. She has also done fill-in work at retail pharmacies throughout her career. Amanda appreciates the wide variety of professional opportunities available to pharmacists. Amanda loves spending time with her family and spends most of her free time exploring new restaurants, hiking in the summer, and snowboarding and cross-country skiing in the winter.
Medication Therapy Management (MTM) is a pharmacist-led service used to improve medication adherence, provide education, and detect adverse drug events and medication misuse. Pharmacists can help identify, prevent and solve drug-related problems that patients may be facing while decreasing the burden on other healthcare providers. Medication therapy management is a collaborative effort between patients, pharmacists, and providers that helps enhance patient participation in their own healthcare. We discuss the five core elements of a model medication therapy management program, as well as potential barriers pharmacists may face while providing this service.
RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is
Pharmacy Technician 0669-0000-22-068-H01-T
Credits: 1 hour of continuing education credit
Type of Activity: Knowledge
Media: Internet Fee Information: $4.99
Estimated time to complete activity: 1 hour, including Course Test and course evaluation
Release Date: December 4, 2022 Expiration Date: December 4, 2025
Target Audience: This educational activity is for pharmacists.
How to Earn Credit: From December 4, 2022, through December 4, 2025, participants must:
Read the “learning objectives” and “author and planning team disclosures;”
Study the section entitled “educational activity;” and
Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)
Learning Objectives: Upon completion of this educational activity, participants should be able to:
Define medication therapy management (MTM)
Describe the core elements of the MTM service model
Identify individuals with disease states and medications that pharmacists may manage through MTM
Identify examples of barriers that may occur when performing MTM
The following individuals were involved in the development of this activity: Amanda Mayer, PharmD, Jeff Goldberg, PharmD, BCPP, and Susan DePasquale, MSN, PMHNP-BC. There are no financial relationships relevant to this activity to report or disclose by any of the individuals involved in the development of this activity.
ⓒ RxCe.com LLC 2022: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of RxCe.com LLC.
A majority of Americans suffer from at least one chronic disease. Chronic disease states lead to significant death and disability in the United States. Medication therapy management was developed to manage these chronic conditions to improve patient health outcomes. Pharmacists and pharmacy staff are critical participants in medication therapy management. This course defines medication therapy management and discusses its history, development, and core elements. It also discusses how pharmacists, pharmacy technicians, and pharmacy staff can avoid barriers to better health outcomes to assist patients through medication therapy management.
Prevalence of Chronic Disease in the United States
According to the Centers for Disease Control and Prevention (CDC), 6 in 10 adults in the United States have at least one chronic disease, with 4 in 10 adults having two or more chronic diseases. Chronic diseases including heart disease, cancer, lung disease, stroke, Alzheimer’s, diabetes, and chronic kidney disease, are the leading causes of death and disability in the US.1 The likelihood of comorbidities increases with age, and more than half of older adults have three or more chronic conditions. In a 2018 empirical study of chronic diseases in the US, it was found that chronic diseases accounted for nearly 75% of aggregate healthcare spending annually.2 From 2015-2018, the percentage of individuals using at least one prescription medication was 48.6%. Twenty-four percent (24%) were using three or more prescription medications, and 12.8% were using five or more prescription medications. Pharmacists can help patients, and other healthcare providers manage these chronic conditions using medication therapy management (MTM).3
Basic Definition of MTM
Medication therapy management is defined by the American College of Clinical Pharmacy (ACCP) as a range of services provided to a patient to optimize therapeutic outcomes and detect and prevent costly medication problems.4 Medication therapy management is patient-centered. The
pharmacist assesses and evaluates a patient’s “complete medication therapy regimen, rather than focusing on an individual medication product.”5 Medication therapy management fosters the development of a relationship with the patient enrolled in MTM services. In contrast, medication dispensing focuses more on an individual medication product.4,6 While a pharmacist will counsel a patient when dispensing a medication, this counseling typically focuses on one product and its interaction with other drugs, but it lacks the comprehensiveness of MTM as it is typically a one-time event.4
This approach can improve adherence, provide education, detect adverse drug events, medication misuse, and solve other drug-related problems. Medication therapy management services rely on pharmacists working collaboratively within healthcare teams to optimize medication use in accordance with evidence-based guidelines. The MTM core elements model, which is outlined below, empowers patients to take an active role in managing their medications and enhances communication between patients and their healthcare team.5
Medication therapy management programs have been an effective method to optimize patient therapy when multiple disease states are involved, and they help improve clinical outcomes and decrease healthcare costs. Pharmacists play a unique role in being able to identify and prevent prescription errors, as well as being able to educate patients on appropriate and safe medication use. Pharmacist involvement in MTM can help to decrease the burden of chronic disease on primary care providers and provide a team- based approach to caring for patients.7,8 Medication therapy management can also help improve provider prescribing habits as pharmacists are specially trained in medication management and may also have more knowledge of insurance formularies.9
Medication therapy management can be implemented in several settings, including community pharmacies, hospital pharmacies, primary care clinics, patient-centered medical homes, managed care health systems, and federally qualified health centers.10 Moreover, strong evidence exists that MTM
services provided by pharmacists and pharmacy staff in the pharmacy setting are effective.10
Short History of MTM
Although similar services have been provided since the 1990s, the term “medication therapy management” was coined by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Centers for Medicare and Medicaid Services (CMS) incorporated an MTM program requirement for individuals with part D coverage in 2006 to help ensure drug regimens were providing optimal therapeutic outcomes. According to the 2009 CMS guidelines, the following three criteria need to be met in order to be eligible for MTM services: multiple chronic conditions, use of multiple covered drugs, and the patient likely incurring $4,000 or more in annual Part D drug costs.11 Since 2010, Medicare has required Part D sponsors to cover at least a portion of MTM costs for eligible beneficiaries that specifically includes an annual medication review and targeted quarterly medication reviews with follow-up interventions when necessary.9
The latest CMS documents, including ones that have information for the year 2023, have the annual cost threshold for beneficiaries for Part D drugs being $4,935.12 Centers for Medicare and Medicaid Services also outlines the targeted beneficiaries for MTM as patients having multiple chronic diseases, with three chronic diseases being the maximum number a Part D plan sponsor may require for targeted enrollment, and individuals taking multiple Part D drugs, with eight being the maximum number of medications Part D plan sponsors may require as the minimum number of Part D drugs a beneficiary may be taking. The number of Part D drugs being taken can be set at a minimum threshold of any number between two and eight.13,14
If a pharmacist is billing Part D Sponsors for MTM, there are very specific CMS-approved MTM elements that should be followed. This CMS standardized format includes very detailed instructions on cover letters, fonts, spacing of words, and tables that are to be included with the MTM documentation. These documents can be found under the Medication Therapy
Management section of cms.gov and should be referenced as needed. Effective January 1, 2022, CMS also requires plans to provide all MTM enrollees with safe disposal of medication information for prescription drugs that are controlled substances in a separate section.13,14 This information includes a link to the U.S Drug Enforcement Administration (DEA) website at www.deatakeback.com and must also include at least two locations of drug take-back sites in the enrollees' community.12
Medication therapy management services have evolved over time from pharmacists providing thorough education on acute medications, such as antibiotics and changes to current therapies, to pharmacists providing education and consultation-type services of chronic medications involving both patients and providers.15 Medication therapy management has been shown over time to help with cost-savings in the healthcare system and increase patient satisfaction when it comes to their overall health and wellness.16,17
Who Can Benefit From MTM
A wide range of patients may be appropriate for MTM services. These patients include the following:5
Transition of care settings
Receiving care from more than one provider
Five or more chronic medications (including nonprescription medications, herbal and dietary supplements)
At least one chronic health condition
Laboratory values outside of the normal range that could be affected by medication therapy
Demonstrate nonadherence to medication regimen
Demonstrate issues of limited health literacy
Desire to reduce out-of-pocket medication costs
Recently experienced an adverse event while receiving care
Patients in a transition of care state - including patients who change healthcare settings, change physicians or have a change in payer status can be especially vulnerable to medication-related problems. During these transitions of care, medication therapy changes are often made to accommodate health status or condition changes, formulary requirements, or other needs and resources.5 Medication therapy management is helpful in these settings to ensure all disease states are taken care of while transitioning and all aspects of healthcare relating to medications are reconciled. Patients can be referred for MTM by physicians, pharmacists, their health plans, and other health care professionals. Aside from transition of care, patients may benefit from MTM when an actual or potential medication-related problem is identified or if the patient is suspected to be at high risk for a problem.5
Patients in the outpatient setting, as well as long-term care (LTC) settings, may benefit from MTM. The goals of MTM in the ambulatory care setting include ensuring the patient is on the right drug and right dose, as well as improving medication adherence. In the LTC setting, MTM can be used to identify issues such as medications without a clear indication, medication overuse, suboptimal dosing, and polypharmacy. Adherence in the LTC setting is typically known and documented by the facility itself.13,14
Clinical outcomes that may be improved by MTM include medication appropriateness and adherence, chronic disease prevalence, quality control, service utilization, and mortality. Economic outcomes that may be improved are decreased cost of medications,11 decreased emergency department visits, and a decrease in hospital admission rates.9 Humanistic outcomes that may be improved include patient satisfaction, better mental health, and increased quality of life.
Common Drugs or Disease States Managed by MTM
Chronic disease states that can be managed by MTM include but are not limited to heart disease, diabetes, asthma, hypertension, hyperlipidemia, osteoporosis, depression, osteoarthritis, COPD, Alzheimer's disease, and end- stage renal disease. Some benefits seen by individuals who received MTM
services were decreases in blood pressure and A1c levels, reduction in negative medication side effects, and increases in overall medication adherence.9 Pharmacists and prescribers may develop collaborative practice agreements with shared disease state management protocols to help MTM work most effectively.10
Core Elements of MTM
The American Pharmacists Association (APhA) outlines a model MTM program that includes five core elements.5 These core elements include Medication Therapy Review, Personal Medication Record, Medication-Related Action Plan, Intervention and/or Referral, and Documentation and Follow-Up. Variations of MTM programs do exist where only some of these elements are required. The five core elements of MTM are activities that pharmacists in all states are authorized to perform, with some states allowing pharmacists to have a wider scope of practice that includes providing certain medical tests.9 Within the proposed MTM core elements service model, the patient would receive an annual comprehensive medication therapy review with additional medication therapy reviews according to the patient’s needs (may include transitions of care, development of new disease state, etc.). The total number of reviews required to manage each patient may vary and is determined by the complexity of the individual patient’s medication-related problems.5
Medication Therapy Review
Medication therapy review (MTR) is the process of collecting patient- specific information, assessing medication therapies to identify medication- related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them.9 The MTR is done between a patient and the pharmacist with the goals of improving patients’ knowledge of their medications, empowering the patient to self-manage their medications and health conditions, as well as addressing problems or concerns patients may have.5
Two types of MTR include comprehensive MTR or an MTR targeted to an actual or potential medication-related issue.5 During a comprehensive MTR, the patient should present all medications, including prescription, non- prescription, dietary supplements, and herbal products, to the pharmacist. It is helpful for the pharmacist to be sure to keep an open interview dialog to make sure patients are not leaving out details that may be of importance. Open-ended questions are helpful in these situations to get the most information out of the patient. During the MTR, the pharmacist should assess medication adherence and potential problems the patient may have in order to identify solutions for resolving issues that may occur.5 Targeted MTRs are used to address a specific actual or potential medication-related problem and are typically performed after a patient has already received a comprehensive MTR. Targeted MTR can be for a new problem or a follow-up on an existing problem. During both types of MTR, the pharmacist should provide education and information to the patient regarding medications and possible adverse events and monitoring to be aware of. In an ideal service model, as laid out by APhA, the patient would receive an annual comprehensive MTR as well as additional targeted MTRs as needed.5
Initially, the patient should be interviewed to gather and clinically assess all the data, including patient demographics, medical and medication history, general health, and activity status.5 CMS recommends a minimum look-back of 6 months to identify current prescriptions and prescribers.13,14 Pharmacists should assess a patient's lab results if available. Face-to-face interviews can be especially helpful to help detect symptoms of adverse effects that may be occurring that the patient might not realize are medication related. It is also important to interview the patient in regard to their thoughts and feelings about their health and medication use. Pharmacists should consider the patient’s quality of life, goals of therapy, values, and preferences, as well as keep in mind cultural issues, education level, literacy level, and language barriers to help assess if these things could affect patient outcomes.5
With the goal of the MTR being to assess, identify and prioritize medication-related issues, pharmacists need to keep in mind the clinical appropriateness of each medication taken by the patient, including the
appropriateness of the dose and dosing regimen. Therapeutic duplications are commonly found during MTR; however, sometimes untreated conditions are identified. Medication cost and healthcare/medication access considerations are commonly addressed during MTR.5 Examples of medication therapy problems may include a patient needing additional therapy, the patient’s dosage being too high or too low, unnecessary drug therapy, a more effective drug being available, adverse drug reaction, and medication non- compliance/non-adherence. Examples of a resolution of a medication therapy problem may include initiating a new medication, changing a medication to something more appropriate, discontinuing or substituting a medication, and working on compliance and adherence.13
Developing a plan for resolving each medication-related problem that is identified during the MTR and providing education and training to the patient are key parts of an MTR.5 Education and training can also include medical devices (such as blood glucose monitors) and not just revolve around medications. Taking time to have important educational conversations with the patients will increase the success of MTR and help patients feel empowered to manage both their medications and overall health. Information about medication-related problems and plans should be relayed to the entirety of the patient’s healthcare team to keep everyone informed and on the same page. Pharmacists may also need to make suggestions to the providers that require follow-up to address issues.5
Personal Medication Record
A personal medication record (PMR) is a comprehensive record of the patient’s medication that includes prescription and non-prescription medications, as well as herbal products and other dietary supplements.9 The patient should receive an updated PMR at each visit or when any changes are made to their regimen. The personal medication record should be used as a tool to promote medication self-management. An advantage of pharmacist- led MTM is that a patient’s PMR is reviewed and updated to suit the needs of the patient. The PMR should be written at a literacy level that is appropriate for the patient so that the patient can easily understand it. In contrast,
patients who do not receive MTM services receive a more generic, hospital- generated list that does not suit their needs or may be inaccurate or confusing.5
Elements that may be included in a PMR are name, birth date, telephone number, emergency contact information, primary care provider as well as other provider information, pharmacy name, and phone number, and the contact information for the pharmacist completing the MTM.5 Personal medication records should include allergies with the reaction to the allergen. Other medication-related problems, including problems that were resolved but should not be repeated, should be noted. Potential questions for the patient to ask about their medications or health conditions when prescribed something new are beneficial for patients to have as a reference. Personal medication records should also include the date last updated. For each medication the following information should be included: medication name, indication, instructions for use, start and stop dates, prescriber, and any special instructions related to the specific medication (take with food, etc.).5
The PMR should be a perpetual document, updated at the time of any changes, and should always be available to the patient. Having this information on hand during any type of admission to healthcare facilities or healthcare visits keeps everyone informed and current on the patient's medication regimen.5 A paper copy may be helpful for many patients to carry in their wallets, but some patients may opt to have this information available electronically (a document on their phone or in their email) for ease of access. Electronic copies may also be easier to update if a printer is not readily available for the patient to use, or the pharmacist may assist the patient in obtaining a hard copy of this document. Personal medication records are helpful in enhancing the continuity of care and easing admission processes and medication reconciliation upon admission to different facilities. They are also helpful as many patients see more than one provider to get comprehensive care of all disease states.5
Medication-related Action Plan
The medication-related action plan (MAP) is a patient-centric document that contains a list of actions for the patient to use while tracking progress for self-management.9 The MAP is created as a collaborative effort between the pharmacist and patient and only includes items that the patient can act on that are within the scope of the pharmacist’s practice or agreed upon by members of the healthcare team.5 The MAP can help as a tool for patients to track their progress and health and medication concerns. The MAP includes action steps for patients, notes for the patient, and appointment follow-up information with the pharmacist if appropriate.5 As of January 1, 2022, providers billing for MTM services under Part D are required to change the name of the Mediation Action Plan to Recommended To-Do List (TDL).13,14 The TDL should not include detailed action plans of the MTM provider but rather the list for the patient.13,14
Intervention and Referral
While completing MTM services, the pharmacist provides consultative services and intervenes to address medication-related problems. The pharmacist refers the patient to a physician or other healthcare professional when necessary.9 Communication with other healthcare professionals is integral to the intervention component of the MTM service model.5 Intervention can also be done with the patient directly when it falls within the pharmacists’ scope of practice. Referrals may be necessary if a patient’s medical conditions or medication therapy is highly specialized or complex. A patient may need to be referred out if they present potential problems during the MTR that need further evaluation or diagnosis. Disease state management education may be needed and may require referrals to other providers. Monitoring for high-risk medications that may require lab draws that a pharmacist could not do with a point-of-care machine would also be a reason for a referral if the pharmacist does not have access to a patient’s lab results. Interventions and referrals should enhance continuity of care, optimize medication use, and encourage patients to seek healthcare to avoid future adverse outcomes.5
Documentation and Follow-up
Medication therapy management services should be documented in a consistent manner that is easy to follow and interpret by all healthcare providers. A follow-up MTM visit should be scheduled based on the patient’s medication-related needs or if the patient is being transitioned from one care setting to another.9 Documentation is an important part of MTM to help with communication between the pharmacist and other providers the patient sees regarding recommendations, monitoring, or potential medication-related problems. Documentation helps improve patient care and outcomes while enhancing the continuity of care for patients. Documentation should be done in compliance with laws and regulations to maintain patient records as well as protect against liability. Documentation is required for billing MTM services as well as demonstrating the value of MTM services.5
The pharmacist should create and maintain patient-specific records that include notes of all care provided to the patient.5 One format that is universal among healthcare providers is a SOAP note which includes subjective observations, objective observations, assessments, and planning, which can be easily interpreted by other healthcare professionals. Educational points given to the patient, as well as any collaboration, are helpful to have in documentation not only for other healthcare providers but also for the MTM pharmacist to reference for follow-up visits.5
Patients should be provided with the PMR, MAP, and additional educational material. Documentation received by physicians and other healthcare professionals on a patient-specific MTM can include a cover letter, the patient’s PMR, the SOAP note, and the patient’s care plan. For billing purposes, the pharmacist may need to provide their name and pharmacy with an appropriate identifier, services provided to the patient, time spent on patient care, as well as appropriate billing codes.5
Follow-up should be done whenever a patient’s care setting changes. Updated MTM and PMR are specifically helpful for change in patient care settings because it helps keep care consistent and everyone informed. Patients
can commonly miss details of their healthcare and medications when changing settings, and MTM provides great benefits with updated PMR when it comes to medication reconciliation between facilities and healthcare providers. Follow-up should also be done when a patient transitions from one pharmacist to another.5
Ways Pharmacy Technicians May Help with MTM
Pharmacy technicians are an integral part of the pharmacy team. Barriers to MTM are commonly staffing shortages and time constraints. Pharmacy technicians may provide administrative support to the pharmacist while it is the pharmacist’s role to do all clinical decision-making. Roles that a technician could perform to create more efficiency in MTM include collecting medication information, documentation, reminder phone calls, and contacting patients about upcoming appointments.18 To ease access to collecting patient information, packets may be sent out in advance for patients to be completed that include things like consent of medical release records, medical histories, and instructions for what to bring to the appointment. These packets may be managed by technicians.
Pharmacy technicians and pharmacy clerks should obtain adequate training on MTM, including areas of MTM that only pharmacists are able to perform. This training helps all pharmacy staff to assist patients with questions regarding MTM and gives a basic overview of what can be expected with MTM services.
Barriers to effective MTM
Arya, et al. (2013) conducted a qualitative study to help understand the perceptions related to pharmacist-led MTM programs among physicians in New York City. This study points out that educating physicians about the role pharmacists can play in the healthcare team was important to help build relationships for a collaborative approach to patient care. This group found that some key concerns of physicians regarding MTM included pharmacist
competency, impact on workload, integration of documentation systems, and effective collaboration between physicians and pharmacists.8
Medication access issues may arise when patients do not have access to indicated medications due to insurance coverage limitations. Some patients are prescribed a less preferred medication due to insurance coverage issues as well as having to discontinue a medication due to insurance coverage reasons.11
Due to the CMS eligibility criteria for MTM, some patients may be excluded from receiving services. Medication therapy management eligibility criteria are predominately based on utilization and economic evaluations, which may work against certain ethnic groups. Various studies have shown that African and Latino Americans tend to have higher rates of certain chronic diseases but also use fewer prescription drugs than European Americans. These underserved minorities might have fewer opportunities to participate in MTM services since they generally obtain fewer healthcare services than European Americans.11,19
Low rates of participation and engagement by patients remain a barrier to MTM. Physician acceptance of a pharmacist's suggestions and recommendations remains relatively low, at about 50%.11 Pharmacists often are not fully integrated into healthcare teams, especially if the pharmacist is practicing in a retail setting. Some pharmacists have ambulatory care positions in clinic settings that allow for more interaction with providers; however, these pharmacists may still struggle as some members of the healthcare team, as well as the patient, may not be as aware of the benefits of a pharmacist’s role outside of medication dispensing.6
Other difficulties that pharmacists may face are inadequate time and staffing, as well as billing difficulties.11 Time can be a large barrier to MTM success. Many pharmacy teams have difficulty implementing MTM into their regular workflow, as it takes time, detail, and many resources to be done at high-quality levels.6 Having a designated MTM pharmacist in a retail setting may be helpful instead of a pharmacist trying to do MTM while keeping the
workflow of a retail pharmacy operating. This also allows for adequate attention to detail to be maintained for proper MTM services. Comprehensive MTRs may require approximately 30 to 60 minutes to perform. Some settings allow for many pieces of MTR data to be collected in advance by chart review, but this is not always the case if the patient is not coming from an integrated healthcare system.11 Lack of and inconsistencies in staffing provide a large barrier to implementing an effective MTM program. Staff turnover presents a struggle not only for training purposes but for quality and consistency purposes as well.
Direct contact with a patient provides for optimal MTM delivery; however, that is not always feasible in today's day and age. Face-to-face interaction is the best way to evaluate a patient and observe visual cues of a patient’s health problems, which may include signs of adverse reactions, lethargy, alopecia, extrapyramidal symptoms, jaundice, and disorientation.5 Other methods of patient contact that may be used are telephone interviews and video communications if the patient is unable to come in for a face-to- face visit. Patient care must always be provided in a private or semi-private setting to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Pharmacists should have access to the proper resources in order to complete MTM effectively. Online resources are a great tool for accessing current information. Printed material for patients is also very helpful, making the use of technology very beneficial for MTM services. Reimbursement for pharmacists’ time and services can be a large and complex issue when performing MTM.
Medication therapy management is an effective way to help patients gain knowledge and feel empowered about their healthcare. Pharmacists play an essential role in MTM when collaborating with patients and healthcare teams to identify and resolve medication-related problems. The needs and literacy levels, as well as patient background and preferences, are important
factors in delivering the best patient-centered MTM. Comprehensive MTM is a great first step in establishing relationships with patients. Targeted, comprehensive MTM, as well as yearly follow-ups, help to ensure the most updated and accurate information. Medication therapy management serves a great benefit in transitions of care and, when done correctly and with attention to detail, can benefit the patient and the entire healthcare team.
Which of the following is NOT a goal of medication therapy management (MTM)?
Transition a patient to pharmacist-only care
Detect medication misuse
Patients in “transition of care” are patients who may be changing
their healthcare settings.
their payer status.
All of the above
Patient outcomes that may be improved with the use of MTM include
better mental health.
Improved quality of life.
All of the above
True or False: During a mediation therapy review, only prescription medications should be accounted for.
A provider’s billing for MTM services under Part D should change the name of the Medication Action Plan to
Recommended To-Do List.
Required To-Do List.
Drug-Related Action List.
Which element is not part of a SOAP note?
True or False: A pharmacy technician may help with administrative tasks of MTM; however, a pharmacist must perform all clinical decision-making.
Key concerns of physicians regarding MTM include
impact on workload.
effective collaboration between pharmacists and providers.
All of the above
What is the ideal circumstance of patient interaction during MTM?
True or False: An advantage of pharmacist-led MTM is that a patient’s personal medication record (PMR) is reviewed and updated to suit the needs of the patient.
Centers for Disease Control and Prevention. Chronic Diseases in America. CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). CDC. Undated. https://www.cdc.gov/chronicdisease/pdf/infographics/chronic-disease- H.pdf. Accessed November 18, 2022.
Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018;15(3):431. Published 2018 Mar 1. doi:10.3390/ijerph15030431
Centers for Disease Control and Prevention. National Center for Health Statistics. FastStats. Therapeutic Drug Use. CDC. 2022. https://www.cdc.gov/nchs/fastats/drug-use- therapeutic.htm#:~:text=Percent%20of%20persons%20using%20at% 20least%20one%20prescription,drugs%20in%20the%20past%2030%2 0days%3A%2012.8%25%20%282015-2018%29. Accessed November 18, 2022.
American College of Clinical Pharmacy. Leadership for Medication Management. ACCP. Undated. https://www.accp.com/docs/govt/advocacy/Leadership%20for%20Medi cation%20Management%20-%20MTM%20101.pdf. Accessed November 11, 2022.
American Pharmacists Association; National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). J Am Pharm Assoc (2003). 2008;48(3):341-353. doi:10.1331/JAPhA.2008.08514
Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. Integr Pharm Res Pract. 2020;9:71-81. Published 2020 Apr 2. doi:10.2147/IPRP.S179628
Rodis JL, Sevin A, Awad MH, et al. Improving Chronic Disease Outcomes Through Medication Therapy Management in Federally Qualified Health Centers. J Prim Care Community Health. 2017;8(4):324-331. doi:10.1177/2150131917701797
Arya V, Pinto S, Singer J, Khan T. Understanding awareness of pharmacist-led medication therapy management among primary care physicians in New York City using qualitative methods: part I. J Med Pract Manage. 2013;29(2):84-88.
Centers for Disease Control and Prevention. Pharmacist-Provided Medication Therapy Management in Medicaid. CDC. 2021. https://www.cdc.gov/dhdsp/docs/MTM_in_Medicaid-508.pdf. Accessed November 11, 2022.
Centers for Disease Control and Prevention. Community Pharmacists and Medication Therapy Management. CDC. Undated. https://www.cdc.gov/dhdsp/pubs/docs/Best_Practice_Guide_MTM_508. pdf. Accessed November 11, 2022.
Ai AL, Carretta H, Beitsch LM, Watson L, Munn J, Mehriary S. Medication therapy management programs: promises and pitfalls. J Manag Care Spec Pharm. 2014;20(12):1162-1182. doi:10.18553/jmcp.2014.20.12.1162
Centers for Medicare & Medicaid Services. Contract Year 2023 Medication Therapy Management Program Information and Submission Instructions. CMS. 2022. https://www.cms.gov/files/document/memo- contract-year-2023-medication-therapy-management-mtm-program- submission-v041522.pdf. Accessed November 16, 2022.
Centers for Medicare & Medicaid Services. Medication Therapy Management. CMS. 2022. https://www.cms.gov/Medicare/Prescription- Drug-Coverage/PrescriptionDrugCovContra/MTM. Accessed November 14, 2022.
Centers for Medicare & Medicaid Services. MTM Program Standardized Format and Technical Instructions. v2.22.2022. CMS. 2022. https://www.cms.gov/files/zip/mtm-program-standardized-format-and- technical-instructions-v2222022.zip. Accessed November 14, 2022.
Barnett MJ, 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. doi:10.18553/jmcp.2009.15.1.18
de Oliveira DR, Brummel AR, Miller DB. Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System. J Manag Care Spec Pharm. 2020;26(9):1057-1066. doi:10.18553/jmcp.2020.26.9.1057
Tate ML, Hopper S, Bergeron SP. Clinical and Economic Benefits of Pharmacist Involvement in a Community Hospital-Affiliated Patient- Centered Medical Home. J Manag Care Spec Pharm. 2018;24(2):160-
Gernant SA, Nguyen MO, Siddiqui S, Schneller M. Use of pharmacy technicians in elements of medication therapy management delivery: A systematic review. Res Social Adm Pharm. 2018;14(10):883-890. doi:10.1016/j.sapharm.2017.11.012
Munshi KD, Shih YC, Brown LM, Dagogo-Jack S, Wan JY, Wang J. Disparity implications of the Medicare medication therapy management eligibility criteria: a literature review. Expert Rev Pharmacoecon Outcomes Res. 2013;13(2):201-16
The information provided in this course is general in nature, and it is solely designed to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.
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