Medication Therapy Management
Resources for States
Conference Call Summaries
Resources from CMTM
Medication Therapy Management
(MTM) was first recognized in law with the passing of the Medicare
Modernization Act in 2003. Each Medicare Advantage (MA) and Prescription
Drug Plans (PDPs) must include MTM programs for their enrollees. Under
the Medicare program, targeted MTM beneficiaries must have multiple
chronic conditions, be taking multiple medications and are likely to
incur high drug costs (>$4,000 in 2006).
This is the criteria for MTM under Medicare Part D as defined by
the law. For Medicare programs, CMS regulations further qualify that
MTM Programs may include elements that promote:
Enhanced enrollee understanding (via education, counseling
and other means) that promotes the appropriate use of medications
and reduces the risk of potentially adverse events
Increased enrollee adherence
to prescription medication regimens (such as refill reminders, special packaging, & other
Detection of adverse events and patterns of overuse and
under-use of prescription drugs
However, it is important to note that MTM programs are not limited
to Medicare Part D plans. In addition, it is important to note that
MTM services could potentially be provided by other health care professionals,
so we need to recognize plans that include pharmacists as part of their
CCRx MTM Program (
Pharmacies have recently received information on the
Care Rx (CCRx) MTM Services Program
, which is available through
a company called
. This program affords your
pharmacy the opportunity to be compensated for providing MTM services
that will positively impact your patients’ quality of life
and possibly reduce their healthcare costs.
To participate in, receive training for, or simply learn more about
this program, contact Community MTM at (703) 683-1955 or visit
In order to sign up for this program, you must fill out a contract
with CCRx and Community MTM. Both contracts are available on the website
Also offered by CCRx, is a billable service known as the
to CCRx Medication Reviews: Helping Your Patients Transition into
. Benificiaries who enrolled in CCRx during June or after
will have a new benefit, the “Welcome to CCRx Medication Review.” The
Welcome Review is a review of all of the patient’s medications
that will be conducted face-to-face with the patient’s pharmacist.
Because the Welcome Review is part of the CCRx transition process,
the service is offered to beneficiaries free of charge and is voluntary.
Outcomes Pharmaceutical Health Care™ (
XLHealth Selects Outcomes™ for Multi-State Medicare MTM Program
Outcomes has administered community pharmacy-based MTM programs since
1999. Seven years of experience have allowed Outcomes to build a nationwide
network of “Outcomes Personal Pharmacists” that includes
over 5,000 pharmacists. Outcomes works with Medicare plans, Medicaid,
self-insured employers, pharmaceutical manufacturers, and others to
improve quality of care and reduce costs for MTM-eligible patients.
Over 65,000 MTM claims have been submitted in Outcomes-administered
These services include:
: Your Outcomes™ Pharmacist
will meet with you to review all your medications. This will
help identify any duplications or conflicts and help to organize
your medication schedule.
: Your Outcomes™ Pharmacist
will confer with you and your doctor(s) to resolve any problems found
with your medications.
: Non-prescription drugs
(over-the-counter) can resolve minor ailments easily and inexpensively.
Your Outcomes Pharmacist will help you to treat a variety of conditions.
: When starting with a new medication,
your Outcomes™ Pharmacist will: 1) Talk to you about its
purpose and correct use; and 2) Follow-up to make sure the drug is
working right and you are not having any problems.
Pharmacies must contract with Outcomes™ and participating pharmacists
must go through the web based training in order to be recognized as
an Outcomes™ Pharmacists. For more information, call (515) 237-0001
or go to
In addition, also offered by Outcomes™ is the
. Outcomes™ is administering a national MTM program
focused on mental health. The one-year program is open to patients
new to the use of Seroquel® in the management of acute manic
episodes associated with bipolar I disorder. Participating community
pharmacies and community mental health center pharmacies may enroll
up to 600 patients in the initial phase of this program. For additional
information on the program and how to become a provider, please go
Humana MTM Program (
PHARMACY NEWS BULLETIN #31
- E1 Transactions
Humana’s MTM program
provides pharmacists an opportunity
to help a lot of Medicare beneficiaries with their medication questions
and to get paid for that service. Humana depends on pharmacists to
provide face-to-face consultations with eligible Medicare beneficiaries.
For answers to questions about Humana’s MTM program, to learn
how to join its MTM Network, and to access a fax form to request participation,
First Health Select
Select Rx Checkup
in PDF format
Trifold informational packet
outlining billing specifics
First Health Select Rx Checkup is a cognitive service provided by
Registered Pharmacists to First Health Select Medicare Part D members.
First Health Select (FHS) recognizes the important role that pharmacists
can play in patient care. With the extensive medication knowledge
possessed by this profession, and the fact that our members most
likely come in contact with their pharmacist more often than any
other health care professional, we believe they are an underutilized
resource to improve patient outcomes.
How the First Health Select Rx Checkup will work:
The FHS member would contact the pharmacy to schedule an Rx Checkup
The Pharmacist sets aside an adequate amount of time to review
the patient’s medication history as well as interview the patient
regarding medical conditions and OTC medications.
The Pharmacist documents this encounter on the “FHS Rx Checkup
Progress Note Form”. Recommendations for changes in therapy
should be included on this form and faxed back to FHS as well as
the patient’s primary care physician.
Examples of Discussion Topics/Interventions:
Drug-Disease state interactions
Duplication of therapy
Low dose/High dose alerts
Therapeutic substitution opportunity
Side effect counseling
Proper Medication administration (time of day, with or without
food, dosing intervals, etc)
Confirm patient understands what each drug is being used for
Recommendations consistent with national guidelines (Post MI not
on a beta blocker, etc)
Suggested lab testing
Overuse and potential abuse issues
Other clinically appropriate interventions/prescriber consultation
This counseling session will allow pharmacists to take a break from
the dispensing role and use their expertise to improve patient outcomes.
This service will be paid for by First Health Select once per member
per calendar year at
the rate of $30 per Rx Checkup.
Pharmacies in need of technical assistance, call Caremark Pharmacy
Provider Help Desk at 1-800-421-2342.
Pharmacies looking for more information on becoming a First Health
Part D or AdvantraRx pharmacy provider, contact Maria Scalise, Director
of Pharmacy networks at 412-553-7548.
Additional Resources on Medication Therapy Management: