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Medication Therapy Managementat the Forefront of Quality Improvementby Savi Lenis, RPh,Pharm.DFMQAI Sr. ProjectCoordinatorTampaMedication therapy management (MTM) isessentially the steppingstone towards thefuture of collaborative health care. The needfor MTM arises from the estimated growth ofMedicare beneficiaries from 41.7 million in 2004 to78.3 million in 2030. 1 Medicare Part D drug expenditureis projected to be $724 billion during the period2006-2015, thus increasing the need for MTM. Underthe Medicare Modernization Act of 2003 and itsimplementing regulations, Part D drug plan sponsorsare required to establish an MTM Program (MTMP).This program is designed to optimize therapeutic outcomesfor targeted beneficiaries by improving medicationcompliance and reducing adverse events.Targeted beneficiaries are defined in the statute asindividuals who have multiple chronic diseases, aretaking multiple covered Part D drugs, and are identifiedas likely to incur annual costs for covered Part Ddrugs of at least $4,000. Drug plans may offer MTMServices (MTMS) at varying levels to Medicare Part Dbeneficiaries. In order to find out if a beneficiary iseligible to receive MTMS, instruct patients to contacttheir drug plan or local pharmacy.One of the varying levels of MTMS available toMedicare Part D beneficiaries is an in-person consultationvisit with a MTM pharmacist. This face-to-faceinteraction establishes or enhances the pharmacistpatientrelationship. Currently, retail MTM pharmacistsare being reimbursed by drug plans like Humana,AvMed and Memberhealth to provide MTMS. Theadvantages of utilizing retail MTM pharmacists includeaccessibility and the optimal ability to observe signs ofand visual cues to the patient’s health problems, such asadverse reaction to medications, lethargy, alopecia,extrapyramidal symptoms, jaundice and disorientation.Pharmacists will have a number of responsibilities thatinclude but are not limited to: monitoring refill historyand over-the-counter medication use, assessing patient’shealth status, initiating or modifying medication therapy,and monitoring and evaluating patient’s response totherapy. Comprehensive medication reviews, utilizationof lab values and effective communication with prescribingproviders are essential to a successful outcome.A care and medication treatment plan will be providedto patients after communicating with the prescribingprovider by telephone or facsimile for approval or furtherrecommendations.Most importantly, collaborative health care has beenfound to produce better outcomes. 2 The ultimate goalof the MTM service is to improve U.S. health care byhelping Medicare beneficiaries use prescription drugsmore appropriately and effectively. Prescribingproviders, who will remain at the center of patient care,plays an essential part in the success of the MTMS. Thefoundation of MTMS relies on the collaborative effortsof the MTM pharmacist, prescribing provider andpatient. MTM pharmacists will not be able to performMTMS without first obtaining and verifying medicaland laboratory information from the prescribingproviders. As a result of MTMS, it is imperative thatefficient and effective communication exists in order toimprove patient self-management. Providers can benefitimmensely from the MTM program. By havingMTMS readily available in the community, patientswill have a direct liaison to their prescribing provider.This allows pharmacists to field patient questions, thusoptimizing provider time. This service will also assistproviders with formulary compliance and improvemeasures for pay-for-performance.The Center for Medicare and Medicaid Services(CMS) has said that MTMS must “evolve and becomea cornerstone of the Medicare Prescription DrugBenefit.” 3 In an effort to successfully implement andassess the impact of pharmacist face-to-face MTMSon patient self-management, CMS has contractedwith FMQAI, the Medicare quality improvementorganization for the state of Florida. FMQAI will providetechnical assistance to the prescription drugplans and pharmacies that serve beneficiaries in thestate. For more information, visit www.fmqai.com, orcontact Savi Lenis, Pharm D, senior project coordinator,Physician Practice Medicare Part D project, at(813) 865-3528 or slenis@flqio.sdps.org.Resources1. 2005 Medicare Board of Trustees Report, “Medicare Data forCalendar Year 2004,” Table II.B1.p.42. Medication Therapy Management Program. Summary of PlanRequirements. Released January 21, 2005.3. Medication Therapy Management in Community PharmacyPractice. Core Elements of an MTM Service.4. April 29, 2005This material was prepared by FMQAI, the Medicare qualityimprovement organization for Florida, under contract with theCenters for Medicare & Medicaid Services, an agency of theU.S. Department of Health and Human Services. The contentspresented do not necessarily reflect CMS policy.FL20071dFT1D13181026722