Transcript Slide 1
1 Origins of Medication Therapy Management • Federal legislation of the 1990’s • Medicare Payment Advisory Commission report of 2002 • Archives of Internal Medicine (Aug. 2003) • Pharmacy consensus statement of 2004 2 MTM Consensus Definition “MTM is a distinct service or group of services that optimize therapeutic outcomes for individual patients. MTM services are independent of, but can occur in conjunction with, the provision of a medication product.” Approved July 27, 2004 by AMCP, AACP, ACA, ACCP, ASCP, APhA, ASHP, NABP, NACDS, NCPA, and the NCSPAE. 3 MTM and Medicare Part D • MTM is a stipulation of Part D legislation • Part D Plans must have MTM program – May be provided by pharmacists 4 MTM and Medicare Part D • Plans must target high risk beneficiaries (at minimum) – Multiple chronic conditions – Multiple medications – High drug costs (>$4,000 in 2006) • Plans must reimburse providers for time and resources 5 Purpose of MTM • To optimize therapeutic outcomes • To decrease the likelihood of adverse events • To enhance patient understanding and adherence • To reduce overall healthcare spending 6 MTM Activities • • • • Assess patients’ health status Devise medication treatment plan Select, modify and administer medications Review current medications and identify drug-related problems • Communicate care to other providers • Provide patient education • Refer patients for broader disease management services 7 The MN-Medicaid MTM Law • • • • • • • Enacted July 2005 (12 yrs of legislation) Service definition Patient eligibility Pharmacist eligibility Place of service specifications Private patient care area requirements RBRVS billing framework using MTM CPT codes 8 MN-Medicaid MTM Compensation • 0115T: First encounter, face-to-face, first 15 minutes; $52.00 • 0116T: Follow-up encounter, same patient, first 15 minutes; $34.00 • 0117T: Additional increments of 15 min of time for 0115T or 0116T; $24.00 9 MTM: Managed Care Perspective • Over 95% of MCO enrollees have a Rx benefit • Many MTM services are part of SOP – Brown bag reviews for new enrollees – Drug utilization reviews – Coordination of medications among multiple prescribers • Warfarin Clinics – Pharmacists review pt medications and INR values to determine dosing – Total patient care 10 MTM: Managed Care Perspective • MTM is necessary piece of patient care – – – – Reduce medication redundancy Avoid harmful drug/drug interactions Use edits within IT systems Encourage adherence • MTM under Medicare – Necessary for vulnerable population – Aligns with MA-PD philosophy – PDPs have greater challenge 11