MTM Toolkit

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.

MTM Toolkit

Resources for States

Resources from Mirixa

CCRx MTM Program (www.mirixa.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 Mirixa Corporation. 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 Mirixa at (703) 683-1955 or visit www.mirixa.com. In order to sign up for this program, you must fill out a contract with CCRx and Mirixa. 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 are newly enrolled in CCRx 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.

In addition, CCRx is offering the Formulary Review program. The focus of this billable service is formulary interchanges in order to save the beneficiary money on their medications. Beneficiaries qualify for this program if they are taking certain targeted medications. Again, the service is offered to beneficiaries free of charge and is voluntary.

  • Welcome to Medicare
    • Fact Sheet
    • Reminder Card
    • Member Card
    • Final Document in Post Enrollment kit

Attention Student pharmacists
Mirixa Contract
MTM Encounter Guide
Mirixa FAQ
Pharmacy Outbound script
Preparing your pharmacy for MTM
LTC Encounter Guide
LTC FAQ
MirixaPro Fact Sheet
Helping your CCRx Patients get the most out of MTM 07

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

Outcomes Pharmaceutical Health Care® (Outcomes®) is a national administrator of pharmacist-provided, face-to-face Medication Therapy Management (MTM) programs. Founded in 1999, Outcomes has built a nationwide network of local pharmacists that deliver MTM services to covered patients.

Over 2 million patients nationwide are eligible for Outcomes MTM programs. Outcomes works with Medicare plans, Medicaid/state programs, self-insured employers, health plans, pharmaceutical manufacturers, and others to improve quality of care and reduce costs for MTM-eligible patients. For an overview of current Outcomes programs, visit www.getoutcomes.com.

Covered MTM services in Outcomes programs include:

  1. Comprehensive Medication Reviews (CMR)
  2. Prescriber Consultations
  3. Patient Compliance Consultations
  4. Patient Education & Monitoring

To be eligible to participate in Outcomes programs, pharmacy contracting and pharmacist training must be completed.

To complete pharmacy contracting:

  1. Go to www.getoutcomes.com
  2. Click on the tab labeled “Pharmacists” at the bottom of the screen
  3. Select “Pharmacy Contracting”

To complete the Outcomes Personal Pharmacist™ training program:

  1. Go to www.getoutcomes.com
  2. Click on the tab labeled “Pharmacists” at the bottom of the screen
  3. Select “Pharmacist Training”

For more information, contact Outcomes at 515-237-0001 or info@getoutcomes.com.

Humana

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

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:             

Pill Card Can Help Patient Adherence
Free, online instructions for creating a pill card—an illustrated medication schedule—using only a personal or lap top computer and printer are now available from the Agency for Healthcare Research and Quality, a part of the Department of Health and Human Services.

One in four Americans do not take prescription medicines as prescribed. Medication non-adherence costs an estimated $100 billion annually in hospital admissions, doctor visits, lab tests, and nursing home admissions.

Research has shown that using a pill card—which uses pictures and simple phrases to show each medicine, its purpose, how much to take, and when to take it—reduces misunderstandings. A pill card can serve as a visual aid for confirming that patients understand how to take the medicines properly and as a reminder to take medicines. Instructions are available online.