MTM 101: The Economic Benefit of Medication Therapy Management

Medication-related issues account for roughly 1.5 million adverse health events and cost $177 billion each year in the U.S. To help combat this, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which was designed to help optimize the medication therapy the country’s elderly and disabled population receives.

Medication-related issues account for roughly 1.5 million adverse health events and cost $177 billion each year in the U.S. To help combat this, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which was designed to help optimize the medication therapy the country’s elderly and disabled population receives.

The MMA requires each Medicare Part D plan sponsor to offer a Medication Therapy Management (MTM) program to its beneficiaries and now many organizations (pharmacy benefit management companies (PBMs), health plans, and large employers) are using MTM programs to help patients manage their prescription drug intake and trim any related costs. These programs have evolved since their inception, and will likely gain traction with risk-bearing provider organizations continuing to focus on providing quality, cost-effective care over the coming years.

MTM is a highly analytical approach to treating patients with medication and allowing insurers, providers, and patients a safe, efficient and targeted outcome.  MTM can be thought of as a methodology or practice that is adhered to or used to help ensure each patient’s medication treatment plan for appropriateness through three lenses: Analytical, Consultative & Educational.

By monitoring MTM processes to prevent drug duplications or complications; appropriate dosing, administration and adherence is more predictable. This is relevant as pharmacists and doctors assess connections and the likely outcome of medication treatment based on factors including medical condition(s), patient demographics, drug product(s) used, dosage, known allergies, current / past medical history, patient education level and cultural preferences as well as a host of other factors.  Preempting any medication related-problems is the goal – which reduces the likelihood of ER visits, hospitalizations and better outcomes.  Secondarily, it can help patients understand their medication therapy and improve adherence.

With approximately 19% of all drugs prescribed to patients prior to admission to a hospital being contraindicated, the impact of properly utilized MTM programs could be profound. Currently, pharmacists are the primary provider of MTM, with the services often being funded by PBMs, health plans, and large employers.  While pharmacists have proven to be successful in helping increase medication adherence and lowering patient costs, it’s not controversial to assert that physician involvement in the MTM process could also prove valuable.  One supporting study reveals that physicians:

• Fail to provide medication instructions in 19-39% of prescriptions
• Discuss dosing directions in less than 60% of cases
• Review adverse effects in only 33% of cases.

MTM program implementation at the physician level is an area we’re watching closely, but without healthcare systems and hospitals receiving an economic benefit from such programs, it could be an uphill climb.

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