A Medication Therapy Management Program, or an MTM, is a service offered to members of Medicare drug plans who meet specific criteria. Eligible patients with multiple medical conditions have the ability to enroll in these programs, which are funded by a patient’s Part D sponsor (drug plan). Here’s how they work: MTMs allow a patient to schedule a Comprehensive Medication Review (CMR) with their pharmacist to review their medication regimen. Patients receive an individualized action plan based off of their current medication list. This helps ensure that patients are on the right medications, getting the most benefit from their medications, and provide a deeper explanation for why they are on each medication.
To be a targeted beneficiary of an MTM for the year, enrollees are required to meet all of the following criteria:
- Have a maximum of 2 or 3 chronic diseases from a list of nine core chronic conditions.
- Are currently taking multiple Part D drugs, with eight Part D drugs being the maximum number of drugs a Part D plan sponsor can require
- Are likely to incur annual costs for covered Part D drugs greater than or equal to the year’s specified MTM cost threshold.
Pharmacies have reported mixed experiences with MTM programs. For example, they can be time consuming for a small community pharmacy, especially if they serve a large number of patients who require MTM services. On the other hand, MTM programs push pharmacies to act as key participants in the coordination of care for patients who had more clinic visits to many different providers, were prescribed more medicines, those more likely to miss appointments, and live in neighborhoods with lower income and educational levels. This is a crucial endeavor, as the number of these complex patients grows each year.
So, the idea here is that MTM is beneficial for the patient – but what does the patient actually think about this? Or more importantly, what do they even know? After all, half of the success of MTM, including in-person CMRs, will require patient cooperation. If it is hard enough to get patients to adhere to their medication regimen, how will they feel about committing to Comprehensive Medication Reviews with their pharmacist?
Let’s see how some patients felt about MTM when prompted to reflect on them.
In a study completed at the University of Minnesota, a team of researchers explored the actual patient perceived value of MTM services. The study also aimed to identify non-financial barriers that would prevent patients with insurance coverage from receiving the services at all, to develop a better strategy for marketing the benefit to beneficiaries.
The following three focus groups were evaluated in the study:
- Patients who pay out-of-pocket for MTM,
- Medicaid beneficiaries who have MTM covered, but also received incentives for having MTM.
- Patients with insurance plans that cover MTM, recruited by handouts and mailings.
The first two groups, who had received MTM services before, reflected on why they decided to take advantage of MTM in the first place through a series of written questions. These participants described their motivation for receiving MTM, what barriers they encountered, their overall experience, feelings, and thoughts about how MTM should be properly marketed to patients. The answers were then recorded and transcribed into Microsoft word.
The third group never received MTM before, so the questions were slightly different. They were asked to describe their reasoning behind declining the services, what barriers they encountered (if any) when they tried to receive MTM. Additionally, what would make them want to receive it. And again, how should MTM be marketed to patients like them. Again, answers were transcribed into a Word document.
The general feedback drawn from the first two groups were very positive, pinpointing several areas of value from the entire experience. Their responses evoked positive sentiment for the MTM Pharmacists as both a resource and collaborative health coordinator. For example, one participant felt that doctors “just don’t have the time to go over [medications] in detail”. They also cited MTM services as a way to save money as a result of laying out all of their options on the table. As one patient said, “[My MTM pharmacist] says, we could do this but it’s going to cost more for you or less for you. And then I had a choice so I felt like I had more control…”.
Additionally, all three groups –participants that both received and did not receive MTM services, found several common barriers in receiving services in the first place. First, they identified a lack of availability of MTM pharmacists. One participant noted that she had a difficult time seeing her pharmacist on the same day as her doctor because he was only in the clinic three times a week at certain hours. Other participants focused on a lack of their knowledge of MTM services and their personal belief that they did not have a need or the time to take advantage of MTM services as obstacles.
So, what kind of conclusions did researchers draw from this data for the future of MTM implementation?
It appears that many patients don’t envision the possibility of a pharmacist assessing their medication in collaboration with their providers, as it is not fully explained to them from the get-go. This aspect of MTM should be accentuated, as patients who want their provider to drive all aspects of their health care might not seek out MTM services if they don’t already have an accurate picture of the behind-the-scenes teamwork. Researchers from the study states that “It is important pharmacists providing MTM services clearly explain their role within the healthcare team to patients”. That being said, they also highlighted the fact that MTM pharmacists should be cautious not to diminish the reputability of physicians beliefs, but work together to help the patient make decisions about their medication/health.
The relationship of pharmacist-to-patient as a supporter and confidant should not be underestimated, as patients clearly find value in this. Based on results from the study, patients also prefer in-person conversations with their pharmacist.
Pharmacists providing MTM should remain as accessible as possible for these conversations. Patients are often busy during the hours of 9-5 too during M-F, and if no other options exist, they may not invest their time.
Essentially, it is an increase of awareness of the benefits of MTM to the patient population that has the potential to improve its relevance and prevalence in health care. Time is another issue. Alternative approaches and flexibility with appointments on both the pharmacist and patient end would be ideal. As a community pharmacist who already values face-to-face conversation with your patient, incorporating MTM into your daily business on a larger scale will only build upon these relationships and your business as a whole.