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MTM Services

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

  1. Patient has experienced a transition of care, and his or her regimen has changed
  2. Patient is receiving care from more than one prescriber
  3. Patient is taking one or more chronic medications (including prescription and nonprescription medications, herbal products, and other dietary supplements)
  4. 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)
  5. Patient has laboratory values outside the normal range that could be caused by or may be improved with medication therapy
  6. Patient has demonstrated nonadherence (including underuse and overuse) to a medication regimen
  7. Patient has recently experienced an adverse event (medication or non–medication-related) while receiving care
  8. 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:

  1. Performing or obtaining necessary assessments of the patient’s health status
  2. Formulating a medication treatment plan
  3. Selecting, initiating, modifying, or administering medication therapy
  4. Monitoring and evaluating the patient’s response to therapy, including safety and effectiveness
  5. Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events
  6. Documenting the care delivered and communicating essential information to the patient’s other primary care providers
  7. Providing verbal education and training designed to enhance patient understanding and appropriate use of his/her medications.
  8. Providing information, support services, and resources designed to enhance patient adherence with his/her therapeutic regimens.
  9. 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:

  1. 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.
  2. 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.
  3. Opportunities for pharmacists and other qualified health care providers to identify patients who should receive MTM services.
  4. 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).
  5. Processes to improve continuity of care, outcomes, and outcome measures.