Medication Therapy Management
Medication therapy management utilizes pharmacists knowledge-based and clinical skills to improve medication usage in patient care. MTM services vary based on practice area and can include formulary management, complex disease state management and medication therapy.
Medication therapy management (MTM) was validated by its inclusion in the final regulations under the Medicare Modernization Act (MMA) of 2003 in addition to the creation of Medicare prescription drug benefit. While Medicare Part D plans are required to provide MTM services to beneficiaries who meet certain requirements, many other individuals can benefit from MTM programs.
Medication therapy management provides an excellent opportunity for pharmacists to make the most of their clinical expertise and in the process, help patients. It is now possible for pharmacists to be reimbursed for some of the services they have been providing for years.
Click on the topics below for more information on MTM.
MPRO: Michigan Medicare Quality Improvement Organization
This organization provides information on its website for healthcare professionals in regards to beneficiary protection, patient safety and prevention.
Pharmacy Quality Alliance
This organization seeks to improve healthcare quality and patient safety through a collaborative process.
Pharmacy Quality Commitment Program
PQC is a continuous quality improvement (CQI) program that supports you in responding to issues with provider network contracts, Medicare Part D requirements under federal law and mandates for CQI programs under state law.
Well Street Care Management, LLC, strives to be a leader in the design, implementation and management of innovative, cost-effective, patient-centered, value-based pharmacy benefit design services through medication management provided by its network of pharmacists and pharmacies. The vision for Well Street Care Management is to improve the care patients receive through evidence-based clinical practice; reduce overall healthcare costs; and, most importantly, promote the connection between patients, pharmacists and physicians.
Well Street Care Management was created and commissioned by the Michigan Pharmacists Association and Pharmacy Services Inc. to address the emerging opportunity for Michigan pharmacists to provide medication management services. Several business models were developed and tested to best achieve this goal. Based on current market conditions and market timing, it was determined that Well Street could best serve pharmacists by directly contracting with self-insured employer groups to provide a value-based pharmaceutical benefit. Subsequently, Well Street contracts with pharmacists and pharmacies in its pharmacy provider network to provide the medication management service to eligible employees of the contracted employer group. Under this model, Well Street establishes and manages the relationship with the payor and provides the total package of services to support the value-based pharmaceutical benefit. This business model provides administrative and operational freedom for pharmacists, allowing them to focus on providing medication management services to their patients.
To that end, Well Street Care Management supports all parties involved in the implementation, delivery and management of the value-based pharmacy benefit service. The major areas of management support provided by Well Street include, but are not limited to, the following:
- Clinical Management
- Client Management
- Physician Management
- Technology Management
- Quality Improvement
- Virtual Community for Network Providers
- Marketing and Sales Management
For more information on medication therapy management, please conact Well Street Care Management™ Director of Business Development Anton Sheridan at (616) 450-7318.
MIRIXA (CCRx MTM Program)
Mirixa's online technologies assist network pharmacies to help their patients successfully start new medications, adhere to treatment plans, manage treatment-related challenges and become aware of appropriate clinical trials.
Humana MTM Program
Humana offers an MTM program to its members through monthly personalized mailings and consultations face-to-face or by telephone with a health professional.
Medicare Part D Contact Information
View medication therapy management personal contact information for plans across the United States.
MTM Definition & Program Criteria
This documents the pharmacy profession’s consensus definition of medication therapy
management, approved by 11 national pharmacy organizations.
Core Elements of an MTM Service: MTM in Community Pharmacy Practice
This resource provides a model framework for
implementing effective MTM services in a community
pharmacy setting. This model describes core
elements of MTM services that can be provided by
pharmacists across the spectrum of community
pharmacy.
MTMS: A Critical Review
This document identifies
existing MTMS standards of practice and develops an illustrative model for payers to
consider in evaluating the compensation of
pharmacists for MTMs.
MTM Billing Codes—New CPT Codes for Pharmacists
National Provider Identification (NPI) Number
The National Provider Identification (NPI) number will be the single provider identifier, replacing the different provider identifiers, such as the NCPDP number, currently in use for each health plan. Obtaining an NPI number is required under the Health Insurance Portability and Accountability Act (HIPAA) since May 23, 2007. The NPI number is required for pharmacists who wish to bill for MTM services with third parties, as well as for pharmacies.
First Health Services Corporation has subcontracted with the Michigan Pharmacists Association (MPA) to provide clinical detailing services to physicians for Michigan Medicaid’s fee-for-service beneficiaries. MPA recruits pharmacists, who are paid for the cognitive services they provide, while at the same time developing relationships with physicians as members of the healthcare team.
Academic detailing is conducted based upon specific disease state management criteria, as determined by the Michigan Drug Utilization Board and First Health, and is designed to make the most up-to-date drug therapy information available to the provider. Each participating pharmacist is assigned up to five physicians per project for clinical detailing.
The clinical detailing is conducted face-to-face with the healthcare professional in the physician’s office. Every attempt is made to match physicians with pharmacists in their geographic area.
MPA and First Health provide participating pharmacists with the appropriate training and clinical detailing materials. The training program explains the process involved with clinical detailing and prepares participants to provide clinical detailing services. This training may be a live session; however, home study/Internet courses with CE credit may also be available.
Pharmacists are paid $200 per completed clinical detailing face-to-face visit with a physician. Those detailers traveling more than 50 miles one-way will be reimbursed at $0.45/mile for additional mileage over the 100-mile round trip allocation. Each encounter, including travel and time spent in the physician’s office, should take no longer than a couple of hours, at most.
Previous disease states profiled since the program’s inception include GERD, NSAIDs, asthma, diabetes, hypertension, postmenopausal osteoporosis, depression and HRT. More than 3,000 physicians have been visited by nearly 70 participating pharmacist clinical detailers.
If you would like to be involved or have questions, contact Pam Farley. You may also send your CV/resume with an indication of your interest in the project by fax to (517) 484-4893.
October 15, 2010
Maumee Bay Conference Center, 1750 State Park Road #2, Oregon, OH 43618
Michigan Pharmacists Association, in conjunction with Indiana Pharmacists Alliance and Ohio Pharmacists...
