Overview of MTM and specialty pharmacy and how an MTM service can be developed in a specialty pharmacy

More than 1.5 million preventable medication adverse events happen each year in the United States, accounting for a cost of $177 million due to mortalities and morbidities. Delivery of safe, patient-centered, and efficient care requires collaboration between patients and diverse care providers.

Pharmacists are central health care professionals in medication therapy management (MTM) and play a crucial role in improving life quality outcomes among patients by engaging in MTM and specialty pharmacy practices.

MTM represents a broad scope of health care services delivered by pharmacists as health care experts. The therapy focuses on improved collaboration between pharmacists, physicians, and diverse health care providers.

MTM enhances communication between patients and health care providers for the optimization of medication use. Pharmacists apply evidence-based guidelines and consult with physicians supporting appropriate decisions regarding their medication use.

Specialty pharmacy offers high-touch services surrounding drugs for complex conditions; thus, the pharmacist enters formal agreements with physicians that allow them to provide clinical support. Specialty pharmacists deliver services by addressing comprehensive patient needs and medication management after a physician’s diagnosis. 

MTM fits into the specialty pharmacy since pharmacists offer comprehensive information to patients after consultation with multiple care providers. Therefore, pharmacists become part of the overall care delivery program, focusing on assessing and evaluating the patient’s complete medication regimen instead of an individual medication product.


Deployed programs that will aid in the delivery of MTM in specialty pharmacy

Pushing the boundaries of patient care in modern medicine accounts for the increased use of specialty pharmacy services. By the end of 2020, brand, generic, and specialty products will have a total revenue of $483 billion, of which 44% of the revenue comes from specialty drugs. Therefore, specialty pharmacy requires innovative programs that meet the high number of patients and still maintain quality, safety, and efficiency in care delivery.

Pharmacotherapy consults, and pharmacogenomics applications portray crucial programs that will be deployed for appropriate integration of MTM into specialty pharmacy. Call center programs and centralized pay centers also reveal essential programs required in the implementation since specialty drugs may be costly and target specific complex conditions. These programs enhance communication and consultation among pharmacists, physicians, patients, and diverse care providers.


Two programs of interest that can be deployed:

  1. Pharmacotherapy consults: Consults involve the process of obtaining direction from physicians that guides the specialty pharmacists in delivering clinical support to patients for the attainment of therapeutic goals. The program development will begin by having a centralized specialty pharmacy process for prescriptions. The providence of a point of contact for all the specialty pharmacists creates a broad scope of capturing prescriptions and interpreting their therapeutic roles. The centralized specialty pharmacist contact area would be boosted by the development of a call center that receives directions and consultations for 24 hours a day alongside medication education and home delivery. Electronic medical records would be used to standardize pharmacy documents and bring together the physicians’ comments, specialty pharmacists’ input, and patient’s medical information. The clinical and administrative notes in the electronic medical system alongside refill reminders, data entry points, and clinical assessment documentation enhance the safety and efficiency of collaborative care delivery. The high-level coordination between physicians, specialty pharmacists, and patients implements the dimensions of MTM since patients receive evidence-based intervention based on their holistic medication regimen assessment.
  2. Pharmacogenomics applications: Genetic information used in guiding drug therapy decisions enhance the suitability of specific medications on target health complexities. The application begins with the use of biomarkers that reveal the severity of disease hence enlighten the specialty pharmacists in applying MTM precepts. Biomarkers will be used in acting as surrogate reveals of the natural end of survival or irreversible morbidity caused by a disease, thus guide in selecting the appropriate genetic of drugs that prevent the severity and enhance life quality outcomes. The MTM service relying on pre-developed biomarkers and drug genomes are crucial as emergency services that assess the suitability of specific drugs for complex conditions hence offer patient education and evidence-based interventions. 

The information that specialty pharmacists obtain from the biomarkers revealing the severity of disease and relevant interventions will be the core factor for integrating MTM into practice. The information helps the specialty pharmacists to administer quality medication therapies that reduce severity rates alongside patient education that promote medication use. Pharmacogenetic applications, therefore, enhance the role of MTM among the specialty pharmacy field.


Development of a specific scope and unique method of delivery of MTM service in specialty pharmacies

Electronic health records will be used in the delivery of MTM since they contain a wide range of patient information accessible to multiple health care providers. A cloud-based customer relationship management (CRM) software will be used in allowing a telehealth interface between patients, physicians, and specialty pharmacists. The software will facilitate the collection of patient-specific information, thus offering direction for the appropriate medications that should be administered to the patient.

The software will be designed to identify drug-related problems and develop solutions that engage the patient, caregivers, and prescribers in attaining the collaborative goals of specialty pharmacy and MTM. The CRM person-to-person interaction will allow discussion between patients, physicians, and the pharmacists. The interaction will improve the knowledge of the patient about diverse medications and their impact on the body based on the health condition under-diagnosis.

The patient can also raise any concerns for the care providers to address, thereby revealing evidence-based interventions. MTM, as an administrative aspect, will be provided through telehealth in the proposed program, thus enhance the quality of interaction between patients and care providers.


Description of patient management tool/outcomes that capture software and could very easily align with the delivery of patient-facing programs by pharmacists and delivery of MTM

The cloud-based CRM software will act as the management tool since it allows quality interaction between patients and care providers. The broad scope of care through face-to-face interactions facilitated by health care also records the conversations acting as a referral for evaluation of the patient proceedings during MTM interventions. The cloud-based CRM software identified polypharmacy, sets appointments, and refills reminders, thus enhancing practice safety. The specialty pharmacists easily offer patient education alongside the support of physicians on the interface program thus reduce the likelihood of medication errors that would compromise life quality outcomes.

About the Author
Fonda Shu-Ayanji is a PharmD/MPH candidate at Shenandoah University Bernard J. Dunn School of Pharmacy, anticipated to graduate in Spring 2021.

Jonathan Ogurchak, PharmD, CSPis the founder and CEO of STACK, a pharmacy compliance management software, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.


References

  1. Burns, A. (2008). Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). Journal of the American Pharmacists Association, 48(3), 341-353.

  2. Bagwell, A., Kelley, T., Carver, A., Lee, J. B., & Newman, B. (2017). Advancing patient care through specialty pharmacy services in an academic health system. Journal of managed care & specialty pharmacy, 23(8), 815-820.

  3. Chang, K. L., Weitzel, K., & Schmidt, S. (2015). Pharmacogenetics: using genetic information to guide drug therapy. American family physician, 92(7), 588.
  4. The CY 2019 Medication Therapy Management Program Guidance and Submission Instructions memo https://www.cms.gov/Medicare/Prescription-DrugCoverage/PrescriptionDrugCovContra/Downloads/Memo-Contract-Year2019-Medication-Therapy-Management-MTM-Program-Submission-v040618.pdf