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How CMM Helps Meet Medication Therapy Management Requirements

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In 2003, passage of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) introduced many people to the concept of medication therapy management (MTM). As a Pharmacy Times article notes, it was this legislation where the term was first coined. The American Pharmacists Association helped establish and then define MTM, including the various activities encompassing MTM services.

This legislation also introduced Medicare Part D, the outpatient prescription drug benefit for those patients who receive Medicare coverage, and included a mandate (under 423.153(d)) that Medicare Part D sponsors (i.e., contracted organizations) must incorporate an MTM program into their plans' benefit structure. Furthermore, as the Centers for Medicare & Medicaid Services notes, the program must meet a series of requirements.


Leveraging Comprehensive Medication Management for MTM

Organizations working to meet these requirements can lean on comprehensive medication management (CMM) and its components to strengthen their compliance efforts. Below are some of the MTM requirements and thoughts on how CMM helps meet them.

Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use. As noted in a previous Cureatr article, a benefit of CMM is personalized therapy. CMM "… factors in how a patient's health condition, including existing comorbidities; lifestyle; potential barriers to adherence (e.g., health literacy, financial, language; cultural); and other issues may impact medication therapy. Changes are subsequently made to better support the development of a regimen and treatment plan with the best chance for success."

Furthermore, as a report from the CMM in Primary Care Research Team notes, CMM is a care process that "ensures each patient's medications are individually assessed to determine that each medication has an appropriate indication, is effective for the medical condition and achieving defined patient and/or clinical goals, is safe given the comorbidities and other medications being taken (more on medication risks below), and that the patient is able to take the medication as intended and adhere to the prescribed regimen."

Reduces the risk of adverse events. Adverse drug events (ADEs) cause harm to millions of patients every year. As statistics from the Office of Disease Prevention and Health Promotion indicate, ADEs account for an estimated one in three of all hospital adverse events, affect about 2 million hospital stays each year, and prolong hospital stays by 1.7 to 4.6 days. In outpatient settings, ADEs account for more than 3.5 million physician office visits, an estimated 1 million emergency department visits, and approximately 125,000 hospital admissions.

CMM can help significantly reduce these risks. Within the Patient-Centered Primary Care Collaborative's report, "The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes," is a section that describes the implications of clinical pharmacist delivering medication management for complex patients. This section includes the following notes: "Fewer adverse reactions and side effects occur and positive clinical outcomes and better health are realized. Patients gain confidence in the medications and the practitioner, which leads to increased adherence and persistence."

The value of CMM in helping keep patients safe is also why "red-flag waving," including identifying hazardous drug combinations, duplications, and dose changes, is an essential feature of Cureatr's Meds 360° comprehensive medication management app.

Is developed in cooperation with licensed and practicing pharmacists and physicians. In another recent Cureatr article, we highlighted reasons CMM programs thrive when they include collaborative practice agreements (CPAs) between pharmacists and physicians or other providers. An MTM is also enhanced through CMM programs with such agreements.

A Preventing Chronic Disease article discussing collaborative drug therapy management (CDTM), a form of a CPA, notes that, "In MTM as most commonly defined, a pharmacist reviews a patient's medication regimen and must suggest changes to the prescribing physician for approval, rather than make any changes independently. This activity is permitted in any pharmacist's scope of practice. CDTM takes this relationship a step further by enabling the pharmacist to make independent drug therapy changes under a protocol that may enhance the efficiency of the pharmacist and healthcare delivery."

Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP). CCIP is an initiative authorized by the MMA. It is intended to support Medicare fee-for-service beneficiaries with chronic conditions as a means to improve health management, treatment plan adherence, and care delivery while avoiding complications.

CMM programs can play a pivotal role in helping such beneficiaries achieve these objectives under a CCIP. In "Partnering with Pharmacists in the Prevention and Control of Chronic Diseases," a program guide for public health published by the National Center for Chronic Disease Prevention and Health Promotion, the authors highlight CMM and the value it plays in supporting patients with chronic diseases.

The report notes, "CMM includes an individualized care plan that achieves the intended goals of therapy with appropriate follow-up to help the pharmacist determine actual patient outcomes. The pharmacist evaluates the outcome parameters against the patient's individualized therapy goals and reevaluates the patient to identify any new medication-related problems that might interfere with the safe and effective use of medications in the patient's care plan. These follow-up evaluations occur in a time frame that is clinically appropriate for the specific patient as well as his or her medical conditions and drug therapy plan."

Whitepaper: Medication Management Challenges and Opportunities for Payers and Providers


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