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Medication Therapy Management / Medication Check Ups

MTM Toolkit
Medication Therapy Management Resources

(Special thanks to the Minnesota Pharmacists Association for the following MTM Toolkit materials)

Please use the information here to help you with questions regarding MTM. Because we rely on feedback to determine what resources are valuable to you, let us know if we don't have what you need. Email your comments/suggestions to karen@naspa.us .

PHARMACISTS
  1. Cost of Service Calculators - Tools available to assist pharmacists in determining the cost of providing MTM services for use in determining pricing for their services.
  2. Documentation Systems - List of known systems used for the billing and documentation of MTM services.
  3. Sample MTM Presentation to Pharmacists - Template document that can be used to assist other pharmacists in implementing MTM programs in their pharmacy.
  4. Sample Business Plan
  5. Sample Collaborative Practice Agreement - General
  6. Sample Collaborative Practice Agreement - Smoking Cessation
  7. Sample Collaborative Practice Agreement - Anticoagulation
  8. Sample Patient Letter - Letter explaining MTM services to patients, and how they can access MTM services at your pharmacy.
  9. Clinical Guidelines - Up-to-date national disease state guidelines (From VPhA)
  10. Core Elements of MTMs Document (From APhA and NACDS)
  11. CPT Professional Service Billing Codes
  12. Medication Therapy Management Services: A Critical Review - document helps pharmacists define payment methodology using an outside study that defines the costs to provide MTM service. (From APhA)
  13. Medication Therapy Management Services in Community Pharmacy - Order Form (From APhA and NACDS Foundations)
  14. Additional MTM Resources (From APhA)
PAYERS
  1. Overview & Addendum Piece documenting MTM success stories.
  2. Sample Presentation: MTM Beyond Disease State Management .
  3. Sample Presentation to Local Employer
PRESCRIBER OUTREACH
  1. Prescriber MTM Brochure .
  2. Sample letter to prescribers .
PATIENTS
  1. General MTM Patient Brochure
  2. Diabetes -specific MTM Patient Brochure
  3. Sample Presentation to Patients/Patient Advocacy Groups - Explains what MTM services are and how to access services from a local pharmacy.

Clinical Guidelines

It is recommended that all MTM pharmacists should be up-to-date on the following national disease state guidelines:


Current Medication Therapy Management / Medication Review Opportunities

Community Care Rx

CCRx MTM Program

( www.communitymtm.com   or www.ccrx.net )

Click here for additional resources from Community MTM

Pharmacies in Virginia have recently received information on the Community Care Rx (CCRx) MTM Services Program , which is available through a company called Community MTM . 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 www.communitymtm.com . 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 listed above.

Also offered by CCRx, is a billable service known as the Welcome to CCRx Medication Reviews: Helping Your Patients Transition into CCRx . 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.

Welcome to CCRx Medication Review

New enrollees to CCRx with benefit effective dates after July 1, 2006 will have the opportunity to provide a Welcome to CCRx Medication Review, a pharmacist-delivered patient care service, to help with their transition into CCRx and Medicare Part D. While participation in this new program is voluntary, we hope you will educate your patients about the benefit of this service, which is billable for pharmacists and free to your patients.

Pharmacists will be expected to execute specific tasks to complete the review and bill the $40 charge using the Community MTM (CMTM) communications service, a Web-based secure messaging system that is also being used for the CCRx MTM program.

The core set of activities and services of the "Welcome to CCRx Medication Review" include:

  • Using the CMTM system to identify qualified patients and schedule face-to-face "Welcome to CCRx" medication review of about 20-minutes duration
  • Asking patients to bring all of their medications to the review
  • Reviewing the patient’s medication regimen and educating the patient about their medications and/or intervene as clinically appropriate
  • Comparing the patient’s current medications with the CCRx formulary and identifying cost-saving opportunities for therapeutic and/or generic substitution
  • Using the CMTM system to document services conducted during the review
  • Using the CMTM system to bill for the review service

To contract with CMTM and complete the MemberHealth addendum to provide CCRx patient care services, please visit the Community MTM Web site and click on the link "Join Our Network." Follow the instructions to view the service agreements and complete the short form. A representative from CMTM will contact you to verify your information and give you your unique login/password to access the application, which includes training on using the CMTM web application.  If you are a member of a buying group or third  party contracting entity, please check with them to see if they are contracting on your behalf.

Resources from Community MTM


First Health Select

First Health Select Rx Checkup

( www.firsthealthpartd.com )

Letter in PDF format

Patient Trifold informational packet

Document 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-Drug Interactions

  • Drug-Food Interactions
  • 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
  • Patient compliance
  • 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.


Humana

Humana MTM program

( www.humana.com/pharmacists )

Check back for updates on Humana's 2007 MTM Program

Click to go back


Outcomes Pharmaceutical Health Care™

Outcomes™ Announces Medicare MTM Program in Virginia

DES MOINES, IA (January 31, 2007)—Outcomes Pharmaceutical Health Care™ (Outcomes™) has been selected by Optima Health Plan, a service of Sentara Healthcare, to administer the Medication Therapy Management (MTM) services component of the 2007 Optima Medicare Part D prescription drug plan in the state of Virginia.

Under the program, eligible members will receive MTM services from specially trained Personal Pharmacists™ to help them achieve safe and effective results from their medications while controlling costs. Optima is the seventh such Medicare Part D plan to contract with Outcomes for MTM services.

Among the new services available to program enrollees is an annual Medication CheckUp™ which allows members to meet one-on-one with a pharmacist in their area. The pharmacist will review the patient’s complete medication profile to detect any potential conflicts or duplications. Additional services such as patient education, compliance monitoring, and assistance with non-prescription medications will also be available.

Pharmacists or pharmacies who are interested in participating with Optima or other Outcomes administered MTM programs should call 515-237-0001 or visit www.getoutcomes.com .

The Optima plan is available within Medicare’s MA Region 7. For more information visit www.optimahealth.com/optimahealth .

Outcomes™ Increases MTM Payment Rate To Pharmacies

Payment increase the first of many new enhancements for 2007
 

DES MOINES, IA (January 4, 2007) - Outcomes Pharmaceutical Health Care™ (Outcomes™) has announced an increase in payments to pharmacies for the provision of covered Medication Therapy Management (MTM) services.

Effective January 1, 2007, the base Medication Check-Up™ payment for most Outcomes plans will increase from $30 to $50. The increase follows an internal company analysis that once again demonstrated high value in face-to-face MTM services. Claims data was reviewed going back to 2003 and it was found that an estimated $600 was saved in avoidable prescription drug, medical and hospital costs for each covered patient who received the Medication Check-Up service.

“This payment increase was earned by our network pharmacists,” said Outcomes CEO, Tom Halterman. “Analyses of MTM service claims confirm that positive results occur when pharmacists provide face-to-face MTM services to covered patients,” he added. Halterman noted that the payment increase was the first of many program enhancements in-store for 2007.

The Medication Check-Up service consists of an appointment-based comprehensive medication review between a pharmacist and a covered patient to assess and organize the patient’s medication regimen. In addition to the $50 base fee, participating pharmacists may earn additional fees for resolving medication-related problems, complications or cost savings opportunities discovered before, during or after the review.

John Deere Health Care Medicare MTM Program

( www.getoutcomes.com )

Letter in PDF format

John Deere Health Care has elected to utilize community pharmacists as providers of Medication Therapy Management (MTM) services in its Medicare Prescription Drug Plan. A subgroup of plan members is eligible for a full menu of face-to-face MTM services, including plan-initiated services (Automated Encounters) and pharmacist-initiated services. This community pharmacy-based MTM program is administered by Outcomes Pharmaceutical Health Care.

Covered Services – Plan-Initiated (Automated Encounters)
This packet includes one or more pre-identified opportunities to get started today in providing MTM services to eligible John Deere Health Care Medicare members. These pharmacy- and patient-specific Automated Encounters should be completed, as appropriate, and faxed to Outcomes (515-237-0002). No additional contracting or training is required. See Automated Encounter forms in this packet for more information.

Covered Services – Pharmacist-Initiated
In addition to Automated Encounters, pharmacists may bill for the provision of many other services to MTM-eligible John Deere Health Care Medicare members. The covered services, and the corresponding professional fees, appear below:

  • Comprehensive Medication Reviews (CMR) $30.00

  • Physician Consultations $20.00
  • Patient Compliance Consultations $20.00
  • Patient Education & Monitoring $10.00

To be eligible to provide these pharmacist-initiated MTM services and receive professional fees, pharmacists must complete the Outcomes Personal Pharmacist Training program. Training may be completed online (available at www.getoutcomes.com ) or via CD-ROM.

Eligible Patients
To obtain a list of the John Deere Health Care Medicare MTM-eligible patients at your pharmacy, contact Outcomes at 515-237-0001 or info@getoutcomes.com .

Outcomes Pharmaceutical Health Care Background
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 programs.


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