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Medication Therapy
Management (MTM)

A Resource for Tennessee Pharmacies

This page currently provides information about MTM, MTM vendors and Medicare Part D MTM programs offered in Tennessee.  At the present time, all information and links on this page are accessible without a TPA username and password.

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What is Medication Therapy Management (MTM)?

With the passing of the Medicare Modernization Act (MMA) of 2003, all Medicare Advantage and Prescription Drug Plan providers offering Medicare Part D benefits are now required to provide MTM services to beneficiaries.

According to the MMA of 2003, an MTM program is a program of drug therapy management that may be furnished by a pharmacist and is designed to assure that the drugs of Medicare beneficiaries are appropriately used to optimize therapeutic outcome and to reduce adverse drug events.

MTM in the community pharmacy consists of five components:

  • Medication Therapy Review
  • Personal Medication Record
  • Medication Action Plan
  • Intervention and Referral
  • Documentation and Follow-up

Who is Eligible?

Medicare Part D beneficiaries who meet the following criteria are eligible for MTM services:

  • have multiple chronic diseases
  • are taking multiple Part D covered drugs
  • are likely to incur annual costs for covered Part D drugs that exceed a specified level

CMS Medicare Part D MTM Program Requirements

Under 423.153(d), CMS requires Medicare Part D Prescription Drug Plan sponsors to have an MTM program that:

  • Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use
  • Reduces the risk of adverse events
  • Is developed in cooperation with licensed and practicing pharmacists and physicians
  • Describes the resources and time required to implement the program if using outside personnel and establishes the fees for pharmacists or others
  • May be furnished by pharmacists or other qualified providers
  • May distinguish between services in ambulatory and institutional settings
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)

For more information about MTM programs, please visit the CMS website at www.cms.hhs.gov/prescriptiondrugcovcontra/082_mtm.asp.

Program Changes – Effective January 1, 2010

Significant MTM Plan Sponsor Requirement Changes in 2010:

  • Enroll targeted beneficiaries using an opt-out method of enrollment only
  • Target beneficiaries for enrollment at least quarterly during each year
  • Target beneficiaries who:
    1. Have multiple chronic diseases (sponsors cannot require more than 3 chronic diseases as the minimum number of multiple chronic diseases, and sponsors must target at least 4 of the following seven core chronic conditions):  Hypertension, Heart Failure, Diabetes, Dyslipidemia, Respiratory Disease (such as Asthma, Chronic Obstructive Pulmonary Disease (COPD), or Chronic Lung disorders), Bone Disease-Arthritis (such as Osteoporosis, Osteoarthritis, or Rheumatoid Arthritis), Mental Health (such as Depression, Schizophrenia, Bipolar Disorder, or Chronic and disabling disorders).
    2. Are taking multiple Part D drugs (sponsors cannot require more than 8 Part D drugs as the minimum number of multiple covered Part D drugs).
    3. Are likely to incur annual costs for covered Part D drugs that exceed a predetermined level as specified by the Secretary (existing cost threshold, $4,000, will be lowered to $3,000, and sponsors’ targeting criteria should be adjusted accordingly).
       
  • Offer a minimum level of MTM services, including: interventions for both beneficiaries and prescribers; an annual comprehensive medication review for the beneficiary, which includes a review of medications, interactive, person-to-person consultation, and an individualized, written summary of interactive consultation; and quarterly targeted medication reviews.
  • Measure and report details on the number of comprehensive medication reviews, number of targeted medication reviews, number of prescriber interventions, and the change in therapy directly resulting from the interventions.
    All Part D sponsors must establish an MTM program per these requirements. The MTM requirement does not apply to MA Private Fee for Service (MA-PFFS) organizations. However, considering MA-PFFS organizations have an equal responsibility to provide a quality Part D product, CMS encourages MA-PFFS organizations to establish an MTM program to improve quality for Medicare beneficiaries.

For more information about these changes, refer to the 2010 CMS call letter.

MTM Opportunities in Tennessee

•   OutcomesMTM (www.outcomesmtm.com)

OutcomesMTM offers several opportunities to pharmacists in Tennessee, including a partnership with Humana to provide MTM services in Tennessee. This is a significant opportunity for pharmacists to expand their practice.
 

 

UAHC Health Plan of TN

Humana

Launch Date

May 1, 2008

November 1, 2009

Eligible Patients

All plan members are eligible that meet criteria

Subgroup of members

Covered Services

Comprehensive Med Review (CMR)
Prescriber Consultation
Patient Compliance Consultation
Patient Education & Monitoring

Comprehensive Med Review (CMR)
Prescriber Consultation
Patient Compliance Consultation
Patient Education & Monitoring

Reimbursement

Yes

Yes

TIPs

Available

Available

Link

www.getoutcomes.com/userdocs/UAHCUpdated.pdf

www.getoutcomes.com/userdocs/Humana_White_Page_200910.pdf

To learn more about the OutcomesMTM platform and how to become a pharmacist provider, please visit the OutcomesMTM website at www.outcomesmtm.com

For contracting information, CLICK HERE, fill out the necessary contract information, and submit the contract to OutcomesMTM. An OutcomesMTM representative will contact you with further information. To contact OutcomesMTM electronically, CLICK HERE, or call them at 515-237-0001 to speak with a representative.

•   Mirixa (www.mirixa.com)

Mirixa offers numerous MTM opportunities for pharmacists in Tennessee. They have recently expanded their MTM program to include targeted interventions in cardiovascular disease risk management and medication adherence. CommunityCareRx (CCRx) and Blue Cross/Blue Shield offer MTM services to eligible patients though the Mirixa platform.

 

CCRx
MTM Review

CCRxSM Welcome to Community

CCRxSM/PrescribaRxSM
Formulary Review

CCRxSM Medication Adherence

CCRxSM Cardiovascular Risk Program

Launch Date

Currently Active

Currently Active

Currently Active

September 29, 2009

Late October, 2009

Eligible Members

Eligible Patients

Annual Review for Eligible Pt’s

Pt’s w/ Non-Formulary Medications

Pt’s w/ Adherence Issues

Pt’s w/ Increased Cardiovascular Risks

Focus

Comprehensive Medication Review

Improve Transition to CCRx and Provide Medication Review

Formulary Alignment and Cost-Savings

Adherence Assessment/
Intervention and Follow-Up

Patient Education, Med Review for Adherence, Appropriate Therapies, Lifestyle, Preventive Care Assessments, and Interventions

Time Required

30 minutes

30 minutes

15 minutes

15 minutes (Initial)
10 minutes (F/U)

45 minutes (Initial)
15 minutes (F/U)

Reimbursement

Yes

Yes

Yes

Yes

Yes

To learn more about the Mirixa platform and how to become a pharmacist provider, please visit the Mirixa website at www.mirixa.com

For contracting information, CLICK HERE, fill out the necessary information, and a Mirixa representative will contact you, or you can call Mirixa support at 866-218-6649, 8:30 am to 5:30 pm EST, Monday through Friday.

•   PharmMD (www.pharmmd.com)

PharmMD has established a values-based culture and looks for pharmacists - full-time, part-time, and as Independent Contractors across the country - who have a passion for people and for delivering high quality clinical services. For more information, CLICK HERE, send them an email at pharmacists@pharmmd.com, or contact them by phone at 1-866-850-4159.

Resources

American Pharmacists Association (APhA) MTM Central – APhA offers numerous resources to help pharmacists grow their MTM practice:
•  
MTM Core Elements Toolbox
•  
Business Tools
•  
Clinical Practice
•  
Resources

Mirixa and MirixaPro Platforms
•  
Pharmacy Slipsheet
•  
Best Practices
•  
 Academic Partnership Program

OutcomesMTM Platform
•  
OutcomesMTM System Overview
•  
For Pharmacists
•  
For Consumers
•  
For Sponsors
•  
UAHC Health Plan of TN
•  
HUMANA 

PharmMD

Centers for Medicare and Medicaid Services (CMS)
•  
MTM Overview
•  
2010 Call Letter

Tennessee Pharmacists Association
500 Church Street, Suite 650, Nashville, TN 37219
615-256-3023 phone     615-255-3528 fax
tpa@tnpharm.org

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