Scope of Medication Therapy Management Services
A. Separation of MTM from dispensing
- MTMS are provided by pharmacists in several settings. MTMS are distinctive and separate from dispensing services. Pharmacists may, at the time of dispensing, identify patients who would benefit from MTM. However, MTM is more in-depth than traditional medication counseling mandated by Omnibus Budget Reconciliation Act of 1990 (OBRA ’90). MTM is more holistic, generally encompassing the patient’s entire medication regimen in the context of prevention, treatment, and management of conditions and disease states.
B. Protection of patient information
- The provision of MTMS that includes patient interaction, documentation, and billing should ensure patient confidentiality and be compliant with the Health Insurance Portability & Accountability Act (HIPAA).
C. Comprehensive versus focused MTMS
- A pharmacist can design his or her practice to provide several MTMS, including comprehensive medication therapy reviews (MTRs), specific disease state management programs, and/or targeted interventions. For example, a pharmacist may identify via the provision of a comprehensive MTR that his or her patient needs additional care for his or her diabetes (i.e., disease management) or perhaps needs strategies to improve adherence (i.e., targeted intervention).
- Pharmacists providing disease state management services or targeted intervention programs can design their practice to include point-of-care laboratory assessment, cognitive services, product lines, and patient education. Examples of pharmacist-provided MTMS in various health care settings include but are not limited to the following:
- Diabetes
- Anticoagulation
- Hypertension/hyperlipidemia
- Adherence
- Regardless of whether the service is comprehensive or focused, all MTMS involve patient interaction and participation to optimize therapeutic outcomes.
D. Patients who may benefit from MTMS
- Complex pharmacotherapy patients
- Multiple medications
- Multiple disease states or conditions
- Narrow therapeutic index medications
- Medications requiring laboratory monitoring
- High risk for loss of continuity of care
- Multiple prescribers
- Recent transitions of care (e.g., hospital discharge, rehabilitation, skilled nursing facility discharge)
- Evidence of or high risk for medication nonadherence
- Irregular refill history
- History of failure to pick up new prescriptions
- Stockpiling or incorrect pill counts
- Financial burden (e.g., uninsured or underinsured)
- Low health literacy
- Poor transportation
- Patient’s beliefs indicate resistance to treatment
- High-cost regimens
- Noticeable decline in the patient’s health or functionality
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