Frugal Health at the Pharmacy: MTM? CMR?

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MTM or Medication Therapy Management is big news in the pharmacy world

More and more pharmacies are expanding to offer this service to their customers and patients.  There is ongoing MTM, and the CMR or Comprehensive Medication Review.  A CMR is an annual service available to many more patients than take advantage of it.

Why Care?

If you’re insured or know someone who is insured, you probably know someone who is eligible to receive a CMR.  For those eligible, it is no cost to them through a pharmacy.  A CMR can be a stepping stone to taking an active role in understanding your medications and health.  So please, take a look and make sure you or those that you know (hello seniors or their tech savvy kids reading this article!) who could benefit from this FREE to them service take advantage!

The thing is, an astounding number of patients have not yet heard of this service!  It can help simplify and foster understanding and health satisfaction, all of which can mean cost savings (to everyone) and improved health.  All good things.  And yes, your Pharmacist legally has access to this information as a member of your healthcare team, whether you realize it or not.  Please do not be alarmed if you are contacted by your pharmacy about taking advantage of these services.

What Is MTM?

I’ll break this down like I do when explaining it to a friend or family member:

MTM or Medication Therapy Management realistically encompasses just about everything pharmacists do.  Most of these things pharmacists have been doing in some sense for a long time, but they haven’t been services that pharmacists could bill for.  It’s just “part of the job” and something pharmacists take for granted.  Most patients don’t have any idea of the things that are going on behind the counter to get them their medication safely.  If you get a call from your pharmacist asking if you might be overdue for one of your medications, there is a good chance they are performing MTM (thought they might not know it or be getting paid for it).

What’s a CMR all about?

Now that you have a little bit of an idea what MTM is, I’d like to focus on the “CMR” or “Comprehensive Medication Review” and what a great service this is for the groups that are considered eligible.

What generally makes someone eligible for a CMR?  Well, it varies depending on the insurance company, but generally speaking involves people on a certain number of target drug classes (such as diabetes drugs), or people taking a “large” amount of medications as defined by their insurance company.

Minimum Qualifications for CMR for Medicare Part D Patients in 2018:

  • Three or more of the 6 target conditions based on drug therapy classes (High Cholesterol, Diabetes, Heart failure, High Blood Pressure, Asthma/COPD)
  • Eight or more ongoing prescriptions through Part D within the past year
  • An expected annual out of pocket drug spending of $3,967 (based on at least 3 months claims data)

In a CMR the pharmacist sits down with the patient and goes over their list of medications, including over the counter products and supplements.  If you are the patient you should be taking home (or getting mailed out to you in a week or so):

  • A list of all your medications including why you are taking them and who prescribes them for you.
  • An updated list of your medication allergies including what happens in the allergy to help address severity
  •  A list of your current medical conditions.

While the pharmacist is going through all of this with you there is a chance for them to point out potentially duplicate medications, address side effects you are having and if certain medications may be making it worse or if a simple adjustment might improve that side effect.

The pharmacist should also be pointing out where the medications used may not be the most optimal based on up to date standards of treatment related to your particular medical condition, your age, etc.  At the very least, the pharmacist should be helping to generate a list of talking points for you to take to your provider at your next visit so that you can address questions that the visit with the pharmacist might bring up.  Often the pharmacist will follow up on your behalf, especially if requested or if anything major needs to be addressed immediately.  As part of your take home paperwork you should also be getting:

  • An “Action Plan” with talking points/notes on specific topics that need addressing by yourself or with your provider at your next visit.

Studies have been able to demonstrate the improved outcomes that patients who get this kind of one-on-one interaction with a pharmacist have.  Improved health outcomes almost always translates to money savings.  So, many insurance companies are beginning to offer these types of service to their members.   “CMS” or The Centers for Medicare and Medicaid Services, has made it a requirement to offer a CMR to qualified Medicare Part D plan enrollees because of these demonstrated benefits.

The most accessible healthcare professional…

Lastly, did you know most pharmacists (at least those graduating within the last 15 years) are Doctors of Pharmacy with a Pharm.D. degree?  There’s a lot of knowledge sitting behind the pharmacy counter.  Take advantage of the most accessible healthcare professional available to you!

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