Medication Therapy Management

Our Medication Therapy Management (MTM) program helps members avoid inappropriate or potentially dangerous medications, increase medication adherence and optimize medication therapy. By helping to reduce the risk of adverse drug events and elevate the quality of care for members, the MTM program can help prevent costly disease progression and reduce total healthcare expenditures for payers and their members too.

The MTM program reviews member drug therapies related to, but not limited to: high blood pressure, high cholesterol, diabetes, respiratory conditions (e.g., asthma, COPD), osteoporosis, depression, heart failure, rheumatoid arthritis, thrombotic conditions, sleep disorders, mental disorders, and pain and anxiety.

MTM targets the highest risk population determined by predicted annual drug spending and the presence of multiple medications and multiple disease states: under/over utilization, gaps in therapy, inappropriate dosing, drug/disease interactions, duplicate therapies, high-risk medications in the elderly, and cost-effectiveness of medications.

Comprehensive Medication Review (CMR) is a complete medication review of a member’s entire medication history. The MTM program pharmacists systematically review all active medications in a member’s profile for:

  • Appropriateness of each indication(s)
  • Effectiveness of the medication for the member’s condition(s)
  • Acceptable dosage ranges and duration of therapy
  • Gaps in therapies
  • Cost-effective alternatives (e.g., therapeutic interchange, brand to generic conversions)
  • Clinically significant drug-drug interactions
  • Appropriateness of the medication based on member demographics (e.g., age, renal insufficiency)
  • Dose optimization and drug consolidation opportunities

Recommendations are provided to the member’s physician. In addition, the pharmacist reaches out to the member for an annual CMR consultation. Members receive detailed medication profiles and action plans and helpful education materials for reference.

Gaps in Care targets members with certain chronic disease states, such as diabetes, asthma, and heart failure, who are not receiving certain medications for their particular condition. Gaps in Care medication recommendations reflect clinical practice standards and national guidelines, including HEDIS, NCQA, and several other CMS quality measures.

High Risk Medication targets members 65 years and older who are receiving potentially inappropriate medications based on the Beers Consensus Report, the HEDIS/CMS measure, Use of High-Risk Medications in the Elderly, and manufacturer recommendations.

Compliance and Persistency (C&P) identifies members who might not be following a prescriber’s instructions regarding medications.

  • The first C&P component identifies members beginning therapy with a long-term medication, such as a blood-pressure lowering medication. The member is counseled on the importance of adherence with their medication.
  • The second C&P component targets members who are 14 or more days late filling their medication. We identify and review adherence barriers that could be contributing to the non-adherence. We focus on educating members about the benefits of taking their medication as prescribed and supporting members to improve adherence.