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By February 6, 2014Commentary

Medication therapy management focuses on people with multiple prescriptions, who tend to have several chronic diseases and high spending.  Because drugs are often the primary treatment for these diseases, medication therapy management is a method to optimize drug therapies but also to help manage the overall care of these patients.  CMS requires that Medicare Advantage and Part D plans conduct MTM activities and is proposing to significantly expand the pool of persons to whom this requirement applies for future years.  A report from America’s Health Insurance Plans looks at several medication therapy management programs and discerns trends and common features.  (AHIP Report)

One common aspect of the programs is that pharmacists’ roles have been expanded and highlighted.  Clinical pharmacists are now often viewed as key members of care teams and often practice under collaborative arrangements with physicians.  Many of these initiatives are disease specific, usually chronic diseases like diabetes, asthma, high blood pressure and lipid issues.   The pharmacists are often aided by more sophisticated software tools, which have a variety of decision support features and help spot potential drug therapy problems, including deviations from recommended guidelines.  The new software tools often allow for a variety of communication forms, including direct interaction with electronic medical records.

Non-adherence is a large class of issues dealt with, which may include failure to pick up a prescription, often due to cost issues, and not taking the right amounts of drugs or at the right time, which may be due to confusion, forgetfulness or side effects.  Safety is another concern, with a review of potential adverse effects and harmful interactions from multiple medications, including over-the-counter ones.  The more sophisticated tasks, however, which really draw on pharmacists clinical knowledge, include understanding when the dosage may be too low to be effective for a patient, which is a more common problem than people realize, or understanding potential genomic effects on drug choice and metabolizing.  Better drug therapy management can improve quality outcomes, but some research suggests it may also be able to help lower costs, by avoiding ER visits, hospitalizations and readmissions.

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