Medication therapy management (MTM) is a distinct service or group of services that optimize therapeutic outcomes for individual patients. MTM services are independent of, but can occur in conjunction with, the provision of a medication product. MTM encompasses a broad range of professional activities and responsibilities within the licensed pharmacist’s or other qualified health care provider’s scope of practice.
Who benefits from MTM
- Patient has experienced a transition of care, and his or her regimen has changed
- Patient is receiving care from more than one prescriber
- Patient is taking one or more chronic medications (including prescription and nonprescription medications, herbal products, and other dietary supplements)
- Patient has at least one chronic disease or chronic health condition (e.g., heart failure, diabetes, hypertension, hyperlipidemia, asthma, osteoporosis, depression, osteoarthritis, chronic obstructive pulmonary disease)
- Patient has laboratory values outside the normal range that could be caused by or may be improved with medication therapy
- Patient has demonstrated nonadherence (including underuse and overuse) to a medication regimen
- Patient has recently experienced an adverse event (medication or non–medication-related) while receiving care
- Patient is taking high-risk medication(s), (e.g., warfarin, phenytoin, methotrexate)
These services include but are not limited to the following, according to the individual needs of the patient:
- Performing or obtaining necessary assessments of the patient’s health status
- Formulating a medication treatment plan
- Selecting, initiating, modifying, or administering medication therapy
- Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness
- Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events
- Documenting the care delivered and communicating essential information to the patient’s other primary care providers
- Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications.
- Providing information, support services, and resources designed to enhance patient adherence with his/her therapeutic regimens.
- Coordinating and integrating MTM services within the broader health care management services being provided to the patient.
A program that provides coverage for MTM services shall include the following:
- 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.
- Face-to-face interaction between the patient and the pharmacist as the preferred method of delivery. MTM programs shall include structures supporting the establishment and maintenance of the patient–pharmacist relationship.
- Opportunities for pharmacists and other qualified health care providers to identify patients who should receive MTM services.
- Payment for MTM 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 and RBRVS).
- Processes to improve continuity of care, outcomes, and outcome measures.
Pharmacy Services
