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Medication Therapy Management

MTM Toolkit

Resources for States

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Medication Therapy Management (MTM) was first recognized in law with the passing of the Medicare Modernization Act in 2003.  Each Medicare Advantage (MA) and Prescription Drug Plans (PDPs) must include MTM programs for their enrollees. Under the Medicare program, targeted MTM beneficiaries must have multiple chronic conditions, be taking multiple medications and are likely to incur high drug costs (>$4,000 in 2006).

This is the criteria for MTM under Medicare Part D as defined by the law. For Medicare programs, CMS regulations further qualify that MTM Programs may include elements that promote:

  • Enhanced enrollee understanding (via education, counseling and other means) that promotes the appropriate use of medications and reduces the risk of potentially adverse events
  • Increased enrollee adherence to prescription medication regimens (such as refill reminders, special packaging, & other compliance programs)
  • Detection of adverse events and patterns of overuse and under-use of prescription drugs

However, it is important to note that MTM programs are not limited to Medicare Part D plans. In addition, it is important to note that MTM services could potentially be provided by other health care professionals, so we need to recognize plans that include pharmacists as part of their MTM program.

CCRx MTM Program ( www.communitymtm.com   or www.ccrx.net )

Pharmacies have recently received information on the Community Care Rx (CCRx) MTM Services Program , which is available through a company called Community MTM . This program affords your pharmacy the opportunity to be compensated for providing MTM services that will positively impact your patients’ quality of life and possibly reduce their healthcare costs.

To participate in, receive training for, or simply learn more about this program, contact Community MTM at (703) 683-1955 or visit www.communitymtm.com . In order to sign up for this program, you must fill out a contract with CCRx and Community MTM. Both contracts are available on the website listed above.

Also offered by CCRx, is a billable service known as the Welcome to CCRx Medication Reviews: Helping Your Patients Transition into CCRx . Benificiaries who enrolled in CCRx during June or after will have a new benefit, the “Welcome to CCRx Medication Review.” The Welcome Review is a review of all of the patient’s medications that will be conducted face-to-face with the patient’s pharmacist. Because the Welcome Review is part of the CCRx transition process, the service is offered to beneficiaries free of charge and is voluntary.

Outcomes Pharmaceutical Health Care™ ( www.getoutcomes.com )

XLHealth Selects Outcomes™ for Multi-State Medicare MTM Program

Current Outcomes Programs

Outcomes has administered community pharmacy-based MTM programs since 1999. Seven years of experience have allowed Outcomes to build a nationwide network of “Outcomes Personal Pharmacists” that includes over 5,000 pharmacists. Outcomes works with Medicare plans, Medicaid, self-insured employers, pharmaceutical manufacturers, and others to improve quality of care and reduce costs for MTM-eligible patients. Over 65,000 MTM claims have been submitted in Outcomes-administered programs.

These services include:

  • M edication Check-up : Your Outcomes™ Pharmacist will meet with you to review all your medications.  This will help identify any duplications or conflicts and help to organize your medication schedule.
  • Prescriber Consult : Your Outcomes™ Pharmacist will confer with you and your doctor(s) to resolve any problems found with your medications.
  • Non-prescription Consult : Non-prescription drugs (over-the-counter) can resolve minor ailments easily and inexpensively. Your Outcomes Pharmacist will help you to treat a variety of conditions.
  • Drug Information : When starting with a new medication, your Outcomes™ Pharmacist will: 1) Talk to you about its purpose and correct use; and 2) Follow-up to make sure the drug is working right and you are not having any problems.

Pharmacies must contract with Outcomes™ and participating pharmacists must go through the web based training in order to be recognized as an Outcomes™ Pharmacists. For more information, call (515) 237-0001 or go to www.getoutcomes.com .

In addition, also offered by Outcomes™ is the Seroquel® MTM Program . Outcomes™ is administering a national MTM program focused on mental health. The one-year program is open to patients new to the use of Seroquel® in the management of acute manic episodes associated with bipolar I disorder. Participating community pharmacies and community mental health center pharmacies may enroll up to 600 patients in the initial phase of this program. For additional information on the program and how to become a provider, please go to www.getoutcomes.com .

Humana MTM Program ( www.humana.com/pharmacists )

PHARMACY NEWS BULLETIN #31 - E1 Transactions

Humana’s MTM program provides pharmacists an opportunity to help a lot of Medicare beneficiaries with their medication questions and to get paid for that service. Humana depends on pharmacists to provide face-to-face consultations with eligible Medicare beneficiaries. For answers to questions about Humana’s MTM program, to learn how to join its MTM Network, and to access a fax form to request participation, visit www.humana.com/pharmacists .

First Health Select

First Health Select Rx Checkup

( www.firsthealthpartd.com )

Letter in PDF format

Patient Trifold informational packet

Document outlining billing specifics

First Health Select Rx Checkup is a cognitive service provided by Registered Pharmacists to First Health Select Medicare Part D members.

First Health Select (FHS) recognizes the important role that pharmacists can play in patient care.  With the extensive medication knowledge possessed by this profession, and the fact that our members most likely come in contact with their pharmacist more often than any other health care professional, we believe they are an underutilized resource to improve patient outcomes.

How the First Health Select Rx Checkup will work:

  • The FHS member would contact the pharmacy to schedule an Rx Checkup
  • The Pharmacist sets aside an adequate amount of time to review the patient’s medication history as well as interview the patient regarding medical conditions and OTC medications.
  • The Pharmacist documents this encounter on the “FHS Rx Checkup Progress Note Form”. Recommendations for changes in therapy should be included on this form and faxed back to FHS as well as the patient’s primary care physician.

Examples of Discussion Topics/Interventions:

  • Drug-Drug Interactions
  • Drug-Food Interactions
  • Drug-Disease state interactions
  • Duplication of therapy
  • Low dose/High dose alerts
  • Therapeutic substitution opportunity
  • Side effect counseling
  • Proper Medication administration (time of day, with or without food, dosing intervals, etc)
  • Confirm patient understands what each drug is being used for
  • Recommendations consistent with national guidelines (Post MI not on a beta blocker, etc)
  • Suggested lab testing
  • Overuse and potential abuse issues
  • Patient compliance
  • Other clinically appropriate interventions/prescriber consultation

This counseling session will allow pharmacists to take a break from the dispensing role and use their expertise to improve patient outcomes.

This service will be paid for by First Health Select once per member per calendar year at the rate of $30 per Rx Checkup.

Pharmacies in need of technical assistance, call Caremark Pharmacy Provider Help Desk at 1-800-421-2342.

Pharmacies looking for more information on becoming a First Health Part D or AdvantraRx pharmacy provider, contact Maria Scalise, Director of Pharmacy networks at 412-553-7548.

Additional Resources on Medication Therapy Management:             


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