Medication Therapy Management (MTM) is a service provided by pharmacists and other healthcare professionals to help people use medications effectively and appropriately.
The service includes a review of someone’s prescription medications, over-the-counter (OTC) medications, and education on proper usage. According to CDC data from 2018, nearly 25% of Americans used three or more prescription medications during the last 30 days.
MTM Over The Years
Pharmacists have been providing MTM services long before the term was officially recognized. Originally, MTM services were classified as ‘pharmaceutical care’ in the early 1990’s. Fairview Health Services, a large integrated health care system, was one of the first of its kind that implemented a standardized program in 1998. It was named a pharmaceutical care-based MTM practice in 2006.
MTM was officially recognized by the U.S. government with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This act requires all sponsors of Medicare Part D prescription drug plans to establish an MTM program for eligible beneficiaries.
Why MTM?
MTM began due to the nation’s increasing reliance on prescription drugs, and out-of-pocket spending for people has been on an upwards trajectory since the 1980s. This is due in part due to:
- An aging population
- Improvements in medical advancement
- A greater variety of medications available to treat illnesses
- Increasing drug costs
MTM continues to be necessary due to ineffective drug therapy, unnecessary drug therapy, and polypharmacy — the practice of filling medications at multiple pharmacies.
People with multiple chronic conditions tend to have more doctor’s visits and multiple healthcare providers involved in their care. Because of this, their care can be fragmented due to poor communication amongst the providers. In turn, this can drive up costs and hospitalization rates. Preventable medication-related problems are estimated to be one of the top five causes of death for people between 65 to 80 years of age, and they are a major cause of confusion, disability, and loss of independence.
By offering MTM services, pharmacists and other healthcare providers can help prevent medication-related problems and optimize medication usage for people who take medications.
Goal of MTM and How It Can Support People Taking Medications
MTM is useful for people with multiple chronic conditions, complex medication regimens, and high prescription costs. It is also beneficial for people with multiple prescribers and people looking to simply feel more in control of their health journey.
The overall goal of MTM is to help ensure optimal health outcomes for people who use medications. Five core elements are included to help reach this goal:
- Medication therapy review
- Examination of a personal medication record
- Creation of a medication-related action plan
- Intervene or refer if needed
- Documentation and follow-up
First, a medical professional — such as a pharmacist — will review all of a person’s medications to make sure their uses and doses are appropriate. Next, a thorough review of their current medication record will shed light on any compliance issues, duplicate therapy, or any competing prescribers. Third, based on the findings, a specific care plan will be crafted to help address potential compliance issues. Fourth, the medical professional will reach out to the person’s healthcare prescribers as necessary and recommend additional follow-up care as needed. Lastly, thorough documentation of the conversation will include recommended courses of action.
Other potential benefits include:
- Gaining a better understanding of medications
- One-on-one time with a healthcare professional
- Receive recommendation for alternative treatment
- Potential cost-saving opportunities
Pharmacists and other healthcare providers can see the impact of MTM being incorporated into their facilities. MTM services can help improve clinical outcomes, out-of-pocket spend for patients, and overall satisfaction.
Example of a Pharmacist Providing MTM Services
Background information:
- 33-year-old female (referred to here as TJC)
- Past Medical History: hypertension (high blood pressure), depression, mildly obese with sporadic lower back pain
- History of Present Illness: TJC’s hypertension has been well-controlled for the past 6 months. She has improved her diet and exercise habits along with cutting down on her number of cigarettes a day.
- Current Medications: lisinopril 20 mg once daily, Estrostep Fe once daily, escitalopram 10 mg once daily, paroxetine 40 mg once daily, ibuprofen 800 mg up to 3 times a day as needed, acetaminophen 500 mg 2 times a day as needed, Camila once daily
- Social History: Smokes ~2 to 3 cigarettes a day (down from 8 per day), 2 to 3 alcoholic drinks weekly. Married. Works as an accountant in a busy firm.
- Vitals: BP today: 136/82, Weight: 210 lbs, Height: 5’ 5”, BMI: 32
- Medication therapy review: TJC states she has a complete understanding of which medications she is taking, what they are for, and how often she should be taking them. She is not taking any OTC medications.
- Examine TJC’s medication record: When reviewing TJC’s medication record, the pharmacist discovered her primary care doctor and psychiatrist were both prescribing medication for her depression. TJC states that her primary care doctor gave her a prescription when her psychiatrist was on vacation, and she took it because she ran out of medicine. Paroxetine — a type of antidepressant — was prescribed from her primary doctor. Escitalopram — a medication very similar to paroxetine — was prescribed by the psychiatrist. Separately, TJC’s primary doctor switched her from ibuprofen to acetaminophen for her back pain when she was diagnosed with hypertension. Her birth control was switched from Estrostep to Camila due to a hypertension diagnosis.
Based on this background information that the pharmacist, the pharmacist and TJC can work together to create an action plan to help with TJC’s medication compliance.
First, a medication-related action plan is created.
- TJC will discontinue Estrostep, ibuprofen, and paroxetine.
- Will reach out to primary to inform them of the correct antidepressant to update their medical record.
- Continue all prescribed medications as directed and inform other pharmacists or healthcare providers of the plan to start any OTC medications.
Next, the pharmacist can intervene or refer TJC to another healthcare provider if needed.
- TJC’s blood pressure has been well-controlled for the past 6 months due to a combination of medication optimization, decreased smoking, and improved diet and exercise. But, the pharmacist can refer TJC to a nutritionist to learn more healthy eating habits. The pharmacist can also provide TJC with pamphlets on the benefits of smoking cessation and some effective habits to help decrease nicotine intake.
Lastly, the pharmacist needs to document and follow-up with TJC as needed. All specifics of the conversation, action plan, and follow up are documented in TJC’s medical record.
References:
- Advancing the Value of MTM. American Pharmacists Association. Accessible via: https://portal.pharmacist.com/advancing value mtm#:~:text=Medication%2Drelated%20problems%20and%20medication,%24177%20billion%20in%20injury%20%26%20death. Accessed June 15, 2021.
- FastStats – Therapeutic Drug Use. Centers for Disease Control and Prevention. Accessible via: https://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm. Published March 1, 2021. Accessed June 25, 2021.
- Jennifer Gershman PD. Medication Therapy Management Offers Unique Career Opportunities. Pharmacy Times. Accessible via: https://www.pharmacytimes.com/view/medication-therapy-management-offers-unique-career-opportunities. Published March 18, 2021. Accessed June 25, 2021.
- Ramalho de Oliveira D, Brummel AR, Miller DB, et al. Medication therapy management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010 Apr;16(3):185-95. doi: 10.18553/jmcp.2010.16.3.185. PMID: 20331323
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