Epic RX

MTM is More Than Meets the Eye

What first comes to mind when you hear medication therapy management or MTM? Do you imagine a webpage where you check off boxes, type a few sentences and submit for payment? Alternatively, perhaps you envision a pharmacist sitting down with a patient, bottles spread across the table, discussing their medication regimen. The first thing that comes to mind when many pharmacists hear MTM relates to Medicare Part D — documenting and submitting cases via an online platform for reimbursement. However, MTM is much more than just Part D, and there are more ways to earn revenue than just working through an MTM vendor.

A new definition…

The pharmacy and health care landscapes have changed exponentially since MTM became part of Medicare Part D benefits. In March 2018, the Joint Commission of Pharmacy Practitioners (JCPP) approved a new consensus definition and term, replacing the profession’s original definition from 2004. The new broader term, medication management services (MMS), is defined as “a spectrum of patient-centered,” pharmacist-provided, collaborative services that focus on medication appropriateness, effectiveness, safety, and adherence with the goal of improving health outcomes. MMS encompasses any service that fits the definition, which includes MTM but also includes services such as chronic care management, enhanced MTM, med rec, and collaborative med management.

What this means for community pharmacy…

MTM is alive and well, and community pharmacists can continue to provide and bill for MTM services as they have done in the past. A majority of community pharmacies is involved in and earns revenue from MTM programs through OutcomesMTM. Working with MTM vendors is a great way for pharmacists to be introduced to formally providing, documenting, and billing for these types of services, but it is important to know that it does not stop there.

Think of MTM as one item under the umbrella that is MMS. Once you have mastered the basics (completing comprehensive and targeted medication reviews online), ask yourself what is next. Go beyond checking a box on a page to thinking more broadly about medication management. It is what pharmacists do every day, though many do not realize it. If you are providing immunizations, catch a drug-drug interaction, or recommend a new medication to address a gap in therapy, then you are practicing medication management. The important question for pharmacists to ask themselves is if they are being paid for it. Some of these interventions mentioned can be documented and billed via MTM vendors.

Expanding medication management programs beyond MTM vendors…

Developing collaborative practices with prescribers and conducting chronic care management services can take your patient care programs to the next level. Billing opportunities are there, but they can be challenging. However, as national provider status advances and more states pass provider status legislation, more opportunities will appear. Value-based care is where pharmacies that demonstrate to payers and providers that they can improve patient outcomes via the services they provide, beyond a traditional dispensing model, will thrive. Next time you hear the term MTM, your thoughts should not only be OutcomesMTM but the broader medication management that can open up many more possibilities for improving patient care and adding to your pharmacy’s bottom line.

Interested in learning more about this MMS and the opportunity it provides your independent pharmacy? Contact the EPIC Pharmacies Clinical Programs Team online or at 800-965-EPIC (3742). 






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