Pharmacy groups produce a vision for implementing MTM services
A new Medication Therapy Management model designed by the National Association of Chain Drug Stores (NACDS) and the American Pharmacists Association (APhA) presents a flexible framework for community pharmacists to consider in providing Medication Therapy Management (MTM) services. The model is intended to be especially useful for community pharmacists providing MTM services to eligible Medicare beneficiaries under the new Medicare Part D prescription drug benefit, which will go into effect January 1, 2006.
Under Part D, Medication Therapy Management is required to be offered to targeted Medicare patients who have more than one chronic disease, take multiple medications, and incur high medication costs. However, the regulations covering MTM services do not offer specific details on how the services should be delivered.
The model services are designed to improve care, enhance communication among patients and providers, improve coordination of care among providers, and optimize medication use which can lead to improved patient outcomes.
While pharmacy operators and pharmacists are free to individualize their services, the model identifies five core elements for pharmacists to consider using when providing MTM services to their patients:
- Medication Therapy Review (MTR) – Patients receive a medication therapy review consultation from their pharmacist. The scope of an MTR can range from comprehensive to targeted for a specific medication problem. The model advocates for a comprehensive MTR at least once yearly that includes a pharmacist consultation with the patient and/or caregiver to examine the medications the patient is currently using, including prescription medications, nonprescription products, herbal, and other dietary supplements, etc. The pharmacist then works with the prescriber to optimize those drug therapies.
- Personal Medication Record (PMR) – Patients receive a complete list of all their medications after a comprehensive MTR, detailing strength, directions and other pertinent information. Pharmacists will encourage patients to share the list with all of their other health care providers.
- Medication Action Plan (MAP) – Pharmacists help patients develop useful strategies for maximizing the benefits of their medication therapy.
- Intervention on Medication Therapy problems and/or Referral – Pharmacists intervene to address medication-related problems and may refer patients to other health care providers if needed.
- Documentation of Services and Follow-up – Pharmacists will consistently document the services they provide to patients and schedule follow-up visits, as appropriate.
“We believe pharmacists are the ideal members of the health care team to deliver MTM services under Medicare or any other health care program,” said John A. Gans, Pharm.D., executive vice president and CEO of APhA. “The MTM core elements represent an approach to MTM delivery that can be used by pharmacists across the spectrum of community pharmacy.”
In addition to providing a basic framework for pharmacy services, the model is also designed to help community pharmacy enhance its value to the nation’s health care system.
“We realize that innovation drives excellence,” said NACDS President and CEO Craig Fuller. “Community pharmacy has a long history of innovation, and we expect that many pharmacists will develop MTM services for which the core elements can serve as a model. Additionally, this model will educate the health care community, including PDPs and MA-PDs, on the services we can provide and the ways we can provide them.”
APhA and the NACDS Foundation will offer educational tools to help pharmacy operators, pharmacists and their staffs incorporate the concepts of the model they choose into their individual MTM programs developed at their pharmacies. These tools will include a complete operations manual with detailed instructions, forms, and MTM practice guidelines for pharmacists, pharmacy staff, and other stakeholders such as PDPs and MA-PDs. The NACDS Foundation and APhA will also hold a joint educational conference on MTM June 23 and 24 in Washington, DC.
To create an MTM model that can be applied across the community pharmacy setting, APhA and the NACDS Foundation formed an advisory panel of chain and independent community pharmacists that represent a wide variety of practice settings.