Pharmacists can play an important role in medication therapy management (MTM) services to enhance therapeutic outcomes for patients.

Patients are usually eligible to receive services under Medicare Part D requirements if they have multiple chronic diseases, use several medications, and are likely to incur certain drug costs.1 Pharmacist-provided MTM services include anticoagulation monitoring, identifying therapeutic duplication, immunizations, pharmacogenomics, and smoking cessation.1

A major component of MTM services includes a comprehensive medication review (CMR) at least annually to identify OTC or prescription medication problems and create an action plan to resolves the issues, which is one of the Star Ratings measures for which pharmacies are evaluated.1,2 Pharmacists can get involved with MTM through practice settings, including community pharmacies, federally qualified health centers (FQHCs), hospital pharmacies in managed care health systems, patient-centered medical homes, and primary care clinics (online figure).2



MTM interventions can reduce the frequency of certain medication-related problems such as nonadherence and lower some health care use and cost measures, according to the results of a study by the Agency for Healthcare Research and Quality.3

The Ohio Department of Health collaborated with 3 FQHCs to evaluate the effect of MTM counseling sessions on patients with hypertension.2 Pharmacists provided MTM services to 5000 patients receiving care at 1 of the FQHC sites.2 Hypertension control rose to 68.6% among patients receiving MTM counseling from a pharmacist.2

MAKING THE MOST OF MTM
In an interview, Callie Pray, PharmD, an MTM pharmacist for the independent pharmacy Holder Drug in Alva, Oklahoma, discussed her role. She commonly sees patients with asthma, chronic obstructive pulmonary disease, diabetes, hyperlipidemia, and hypertension. Holder Drug uses MirixaPro and OutcomesMTM platforms for reimbursement.
Cardinal Health recently said that it acquired Mirixa, which will be integrated into OutcomesMTM to offer enhanced services for MTM providers.4 Pharmacists can also get in touch with individual MTM platforms for possible full- or part-time positions, which may offer the flexibility of working remotely.

Pray also provides at-home CMRs for patients who are unable to travel to the pharmacy. This innovative and personalized service “allows me to assess much more than the typical CMR conversation in the pharmacy, as I am seeing the environment the patient lives in and [in which he or she] takes his/her medications every day,” she said.

The MTM consults include assessing a variety of drug therapy issues, such as drug interactions, duplication of therapy, and medication adherence.

Pray also provides phone consults and follow-up calls to her MTM patients and works part time as a staff pharmacist at Holder Drug, which is in a rural area and provides delivery services and immunizations as part of its personalized care. Getting to know patients is rewarding, she said, adding that she believes there is a growing trend of pharmacist MTM
job opportunities at independent pharmacies.

CONNECTING WITH INDEPENDENT PHARMACIES

Pharmacists should contact independent pharmacies to assist with developing MTM services for the practice site, which can help build a business. Stopping by in person with a business card and curriculum vitae can may help build rapport with staff members. These pharmacists can help integrate MTM services into the workflow and train pharmacy technicians to identify eligible MTM patients and schedule CMRs.5 Additionally, the MTM pharmacists can train the entire staff through continuing education programs, and vendors can teach the pharmacy team about the MTM portals.5

Technology plays an important part in MTM services, which should be synchronized through the portal with other clinical pharmacy services and patient education programs.5 Pharmacists who are specifically hired to perform MTM services can free up time for other staff members to focus on the dispensing side. A 45- to 60-minute time frame should
be blocked off for each CMR session, and pharmacists should review the medication profile prior to the appointment. Techs can also help document, code, and submit the CMR sessions for payment.5

REFERENCES
  1. Gershman J. The nuts and bolts of medication therapy management. Pharmacy TimesSeptember 2, 2018. pharmacytimes.com/publications/health-system-edition/2018/september2018/the-nuts-and-bolts-of-medication-therapy-management.  Accessed November 17, 2019.
  2. CDC. Community pharmacists and medication therapy management.cdc.gov/dhdsp/pubs/guides/best-practices/pharmacist-mtm.htm.  Updated May 30, 2019. Accessed November 17, 2019.
  3. Viswanathan M, Kahwati LC, Golin CE, et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med. 2015;175(1):76-87. doi: 10.1001/jamainternmed.2014.5841.
  4. Strengthening community-based MTM: Cardinal Health acquires Mirixa. Outcomes website. outcomesmtm.com/cardinal-health-acquires-mirixa/. Accessed November 17, 2019.
  5. McKesson.  Leveraging medication therapy management for independent pharmacies.  McKesson website.   https://www.mckesson.com/Blog/Leveraging-Medication-Therapy-Management-for-Independent-Pharmacies/.  Published May 8, 2017.  Accessed November 17, 2019.