Pharmacy Frequently Asked Questions (FAQs)
What is Medication Therapy Management (MTM)?
Originally a component of the Medicare Modernization act of 2003 and the Medicare Prescription Medication Benefit (Part D), MTM is specifically defined as “a distinct service or group of services that optimize therapeutic outcomes for individual patients [that] are independent of, but can occur in conjunction with, the provision of a drug product.” Specific desired outcomes of MTM are appropriate drug use; enhanced patient understanding of appropriate drug use, increased patient adherence with prescribed drug therapies, reduced risk of adverse events associated with drugs, and reduced need for other costly medical services.
Pharmacists provide MTM to patients identified as having risk factors for adverse medication-related outcomes, such as polypharmacy, multiple prescribers, non-adherence, requiring additional education and delivery device teaching, recent, multiple medication changes or new, high-risk medications.
Pharmacists will coordinate a visit at the provider’s office, in the patient home, or via phone call, and involve other caregivers as needed. The pharmacist performs full medication reconciliation, clinical assessment of the medication regimen; perform medication teaching, and assessment of medication coordination (including procurement, adherence and prescription costs).
Discrepancies and recommendations are communicated to the provider, and the pharmacist will work with the provider and patient to assist with any changes, additional monitoring and education as needed.
* Bluml BM. Definition of medication therapy management: development of profession-wide consensus. J Am Pharm Assoc. 2005;45:566–72.
What is Deprescribing?
Deprescribing is a planned and coordinated process of discontinuing or de-escalating doses of medications (prescription, OTC) which are either inappropriate or are no longer indicated. The process involves the provider, patient and pharmacist, and may require monitoring and ongoing education.
Appropriate patient populations may include elderly, chronic/complex patients with multiple co-morbidities, and patients with multiple prescribers. Medications listed on the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults are usually targeted. Classes such as: Proton Pump Inhibitors, Benzodiazepines, Antipsychotics and Opioids can sometimes be deprescribed. In addition deprescribing can be beneficial when prescribing cascades exist. (e.g.when an adverse drug reaction is misdiagnosed as a symptom of a new condition, and a new medication is prescribed to treat the “new condition” unnecessarily)
Deprescribing has many impacts:
- Improved patient outcomes:
Optimizing regimens through appropriate deprescribing reduces risk of adverse effects, drug interactions, medication related hospitalizations, and increases likelihood of improving adherence and outcomes.
- Improved patient satisfaction:
Quality of life may increase with fewer medications (e.g. fewer adverse effects, lower cost, easier medication coordination) and patients may feel they are receiving a tailored approach to their healthcare.
- Reduced costs to the patient:
Out of pocket costs (co-pays/co-insurance) for a patient taking 10-20 medications may equate to a month’s worth of groceries for a frail senior.
- Reduced costs to the system:
Polypharmacy (concurrent use of five or more medications) is a prominent factor influencing medication non-adherence.