PSTAC

1
PSTAC
Pharmacist Services Technical Advisory Coalition
2
Origins of Medication Therapy Management

• Federal legislation of the 1990s
• Medicare Payment Advisory Commission report of
  2002
• Archives of Internal Medicine (Aug. 2003)
• Pharmacy consensus statement of 2004

3
MTM Consensus Definition

• MTM is a distinct service or group of services
  that
• optimize therapeutic outcomes for individual
• patients. MTM services are independent of, but
  can occur in conjunction with, the provision of a
• medication product.

Approved July 27, 2004 by AMCP, AACP, ACA, ACCP,
ASCP, APhA, ASHP, NABP, NACDS, NCPA, and the
NCSPAE.
4
MTM and Medicare Part D

• MTM is a stipulation of Part D legislation
• Part D Plans must have MTM program
• May be provided by pharmacists

5
MTM and Medicare Part D

• Plans must target high risk beneficiaries (at
  minimum)
• Multiple chronic conditions
• Multiple medications
• High drug costs (gt4,000 in 2006)
• Plans must reimburse providers for time and
  resources

6
Purpose of MTM

• To optimize therapeutic outcomes
• To decrease the likelihood of adverse events
• To enhance patient understanding and adherence
• To reduce overall healthcare spending

7
MTM Activities

• Assess patients health status
• Devise medication treatment plan
• Select, modify and administer medications
• Review current medications and identify
  drug-related problems
• Communicate care to other providers
• Provide patient education
• Refer patients for broader disease management
  services

8
The MN-Medicaid MTM Law

• Enacted July 2005 (12 yrs of legislation)
• Service definition
• Patient eligibility
• Pharmacist eligibility
• Place of service specifications
• Private patient care area requirements
• RBRVS billing framework using MTM CPT codes

9
MN-Medicaid MTM Compensation

• 0115T First encounter, face-to-face, first 15
  minutes 52.00
• 0116T Follow-up encounter, same patient, first
  15 minutes 34.00
• 0117T Additional increments of 15 min of time
  for 0115T or 0116T 24.00

10
MTM Managed Care Perspective

• Over 95 of MCO enrollees have a Rx benefit
• Many MTM services are part of SOP
• Brown bag reviews for new enrollees
• Drug utilization reviews
• Coordination of medications among multiple
  prescribers
• Warfarin Clinics Pharmacists review pt
  medications and INR values to determine dosing
• Total patient care

11
MTM Managed Care Perspective

• MTM is necessary piece of patient care
• Reduce medication redundancy
• Avoid harmful drug/drug interactions
• Use edits within IT systems
• Encourage adherence
• MTM under Medicare
• Necessary for vulnerable population
• Aligns with MA-PD philosophy
• PDPs have greater challenge