Is Comprehensive Medication Management the Best MTM Type?

Comprehensive medication management (CMM) is considered the standard of care that ensures a patient’s prescription drugs, OTC medicines, and nutritional supplements are each appropriate for the patient, effective for the condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.

Proponents of CMM often feel it’s the only type of medication therapy management (MTM) that should be employed and reimbursed. They’re zealous in this belief and strong proponents of insurance coverage for CMM.

I, too, want this pharmacist role to be recognized and covered, but I don’t think it’s the only type of MTM that makes a difference, and I’m afraid CMM proponents may miss the forest for the trees in their eagerness to promote CMM.

I’ve been told CMM can take 60 minutes to accomplish. Some feel such an evaluation can’t be performed by the average community pharmacist, so it requires someone with extra training (like residency), thus limiting who can conduct CMM and where it can take place. However, CMM proponents say it enables health care organizations to achieve the quadruple aim of improved outcomes, cost savings, patient satisfaction, and clinician satisfaction, thus providing a win-win situation.

Another type of MTM is the focused intervention employed by groups like Mirixa and OutcomesMTM. Proponents of this format suggest any pharmacist can perform it anywhere. It saves money and also leads to satisfaction and improved economic outcomes. Plus, the use of focused MTM by payers is increasing, and more pharmacists are contributing to it, as well. So, it also seems like a win-win.

Rather than recognizing that these 2 distinct programs have an appropriate place in health care, proponents of each often feel that supporting one program distracts from support for the other. However, I’ve come to the conclusion that both MTM types work appropriately when used in the right place. The problem is we expect both types to achieve the same outcomes, but they don’t.

I reached this conclusion during a recent conversation with a colleague. While we were a talking about setting up a demonstration project to evaluate CMM, my colleague said she’s been using focused MTM and it has saved money. Some payers wanted it, and she was responding to their demand.

In that moment, I realized focused and comprehensive MTM were different, but each had its place and couldn’t replace the other in a specific situation. I believe pharmacy needs to support both but make sure they’re each used appropriately. By not supporting both, I think we run the risk of not advancing the pharmacist’s role as quickly as needed to ensure appropriately drug therapy outcomes.