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Nearly a quarter of Americans have used five or more prescription drugs in the past month. However, this shouldn’t come as a surprise. As the population ages, more people are taking multiple prescription drugs to treat different chronic conditions such as high blood pressure, diabetes, high cholesterol, chronic pain, and depression. However, the more prescriptions you take, the higher your risk of drug interactions, adverse effects, and forgetting to take one or more medications. This is where medication therapy management (MTM)—and pharmacists—comes in.
MTM was defined and implemented through the Medicare Prescription Drug Improvement and Modernization Act (MMA) in 2003. This legislation established Medicare Part D and the role of pharmacists as key members of the healthcare team. As MTM services continue to be performed across the nation, it’s important that pharmacists and healthcare providers continue developing and refining their medication management strategy.
What is medication therapy management?
The definition of MTM arose out of an extensive group discussion started by the American Pharmacy Association (APhA) in 2004. Participants of the group included members of various pharmacist organizations. They reached an agreement on the definition of MTM, which strengthened the role of pharmacy and the importance of the services that pharmacists offer.
According to APhA, medication therapy management is a particular service or set of services performed to improve the therapeutic outcomes of patients. These services are provided by healthcare providers, including pharmacists, and involve five essential components:
- Medication therapy review (MTR)
- Personal medication record (PMR)
- Medication-related action plan (MAP)
- Intervention or referral
- Documentation and follow-up
Why is medication therapy management important?
MTM is important because it helps patients get the most benefit from their medications. For example, patients may not be fully aware of how to take certain medications, such as inhalers or patches. MTM services also help healthcare systems save on costs linked to medication issues, such as medication errors and potential hospital visits resulting from adverse effects.
Medication therapy management examples
Because it involves a broad range of services, there are many ways that pharmacists and healthcare providers can optimize therapy through MTM. Pharmacists may work within a collaborative practice agreement to perform MTM services. Pharmacy medication management examples include:
- Monitoring the effects of certain medications
- Counseling patients on the appropriate use of their medications
- Evaluating patients’ response to therapy
- Performing a comprehensive review of all of a patient’s medications
- Identifying duplications of therapy or drug interactions
- Educating the patient on lifestyle modifications and non-pharmacological therapies
Medicare plans with prescription drug coverage allow patients to use MTM services for free. Many private insurance plans may also cover MTM services for patients. Eligible patients are usually taking several medications for at least a few different medical conditions. Patients may also qualify if they are part of a program that counsels patients on how to take opioids safely.
If you have a patient you think would benefit from MTM services but does not have insurance coverage, you can recommend they check with their state’s Medicaid program. Some state Medicaid programs help cover MTM services for eligible, low-income patients. These programs may help pay for the initial MTM visit and a set number of follow-up visits in a given year.
Strategies for medication therapy management sessions
Medication therapy management is still a relatively new group of services being developed and expanded. The medication management process can be a comprehensive one, involving both pharmacological and non-pharmacological aspects of care, effective communication with other providers, and appropriate engagement with the patients receiving care. Different clinical practices may have different approaches to MTM. However, the ultimate goal should remain the same: optimize the patient’s therapeutic outcomes.
Here are some tips that you can use to offer effective MTM sessions.
1. Tell your patient about MTM services
Patients won’t participate in MTM services if they don’t know they exist. This is probably one of the most important aspects of MTM since there is no MTM without the patient. Any time you interact with a patient, especially if they’re picking up a medication, you should offer to provide MTM services either at that time or at another point in the future. In some cases, pharmacies may offer incentives to patients to schedule an MTM session—or offer services over the phone if the patient can’t make it in person.
2. Communicate clearly
Teaching medication management should be as straightforward as possible for the patient. Listen to any concerns the patient may have about their medications. Then, advise them on the best way to take their medications. You might recommend taking a particular medication with food, a full glass of water, or at a different time than another medication or supplement to avoid an interaction.
3. Involve pharmacy staff and students
Offering MTM services is an excellent opportunity to involve the entire pharmacy staff. The staff should be trained on different tasks to support an efficient MTM program. Supportive tasks may include offering MTM services to patients at checkout and scheduling appointments. Pharmacy students are also valuable assets who can check the patient’s medication history and prepare the pharmacist for an MTM session.
4. Keep it simple
Try not to use complicated medical terms that the patient may not understand. If you have an in-person session with a patient, you can print easy-to-read handouts or draw out images to explain your concerns as needed.
5. Discuss adherence
Medication adherence is one of the most important aspects of MTM services. Counsel patients on the importance of taking their medications consistently. You might even recommend certain tools like mobile app reminders or pillboxes.
6. Check for possible adverse effects and drug interactions
Patients who opt for MTM services are often at risk of experiencing drug side effects and interactions because they take so many medications. Take a comprehensive approach to the patient’s medication list. Check for an increased risk of side effects due to kidney and liver problems, as well as old age, for example. Review any possible drug interactions or duplications of therapy, and recommend that the doctor or healthcare provider discontinue a particular medication as needed.
7. Take notes and add reminders
It can be challenging to keep track of medication issues across numerous patients. It’s crucial to take notes on the MTM services you provide. Make notes for patient-specific concerns, and add reminders to follow up with patients via phone call or in-person visit after an initial MTM session. You’ll also want to document every patient interaction and attempt to get in touch with a patient. You can document and keep track of these events in a special binder or a computer program, if available.
Success with MTM services
If you notice one of your patients is taking multiple medications—especially ones that need to be monitored closely—has several health conditions, was recently hospitalized, or picks up medications from multiple pharmacies, they are a good candidate for MTM services. Patients with multiple prescribing doctors and high prescription costs are also good MTM candidates. In most cases, your MTM portal will flag eligible patients to keep you on track with your MTM goals.
MTM is a valuable part of what pharmacists offer to patients and the entire healthcare system. Pharmacists often interact with patients more than other healthcare providers when it comes to medication problems. Identifying medication problems quickly and effectively can help guarantee treatment success in patients.
