Research Updates in Medication Therapy Management

In a session at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2019, Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, executive director, The Peter Lamy Center on Drug Therapy and Aging Professor, Pharmacy Practice and Science University of Maryland School of Pharmacy Baltimore, MD, and Michael Steinman, MD, professor of medicine UCSF/SFVA San Francisco, CA, reviewed recent research evaluating updates in medication therapy management (MTM).

Dr Brandt began the presentation providing background and perspective on the evolving MTM program. “We know that there is a lot of variability with how people provide MTM services,” she explained. “As of 2006, the United States Centers for Medicare & Medicaid Services (CMS) began offering a prescription drug benefit known as Part D to Medicare beneficiaries.”

The presentation continued to explain that “participating sponsors in the Part D program must provide eligible beneficiaries with access to medication therapy management (MTM) services and after a comprehensive medication review, a written summary using the Medicare Part D Medication Therapy Management (MTM) Standardized Format (SF) is provided.”

It is here that barriers to the integration of the SF into electronic medical records exist, as well as the lack of portability of SF. “There is limited beneficiary-centered evidence on the utility of the [SF], especially from the beneficiaries’ perspective,” explained Dr Brandt.

Dr Brandt explained that while we understand what MTM offers and how it can vary, “What we don’t know a lot about is the end-user experience after a comprehensive medication review. What is the patient’s perspective on this standardized format?”

Patient Feedback

The study Dr Brandt and colleagues conducted sought to better understand beneficiary, caregiver, and/or care managers’ perceptions of the Medicare Part D MTM SF. This research was also intended to evaluate the utility of the SF to inform potential modifications for optimal use. The research timeline included institutional review board approval, pre-focus groups, focus groups, post focus groups, pre-surveys, and a national survey.

One of the most common concerns with medication information from Medicare beneficiaries during the focus group interviews was where their information was stored, what it was used for, and who had access. Participants suggested that MTM could be improved by including data on side effects, drug interactions, generic names, copay information, and descriptions of the differences between mandatory and priority drugs. 

“In our focus groups, in terms of the medication action plan, our participants said they would like to be able to record instructions somewhere, specifically those with diabetes, having a place to add information would be beneficial. Others said that a checklist would suffice,” explained Dr Brandt. 

For patients that used the SF comprehensive medication review, 6.4% said they looked at it often but 37.5% reported they did not look at it at all. One of the major themes that emerged from the research was that the lists needed to be more concise and more portable. 

Provider perspective

Dr Steinman, who often focuses on research on improving patient outcomes, spoke shortly during the second portion of the session from the prescriber perspective on the MTM program. Among his top recommendations for improving the MTM program for patients is increased collaboration between providers rather than relying on bureaucratic recommendations.

“Even though the Beers Criteria are not intended to be dogmatic, they are often applied as such…which gives the impression that they are burdensome rather than their intention to be helpful,”
Dr Steinman continued. “As a clinician, what I love to get is a consult from a partner or another clinician,”
stressing that collaboration is key and valuable. 

Dr Steinman identified some key patient-centered priority areas for improving medication management and adherence that the Centers for Education and Research on Therapeutics stakeholders outlined. They included: (1) creating tools and systems to facilitate and evaluate patient-centered medication management plans; (2) developing training on patient-centered prescribing for providers; and (3) increasing patients’ knowledge about medication management. 

Future Initiatives

The third portion of the session further reviewed the MTM model focusing on the capability maturity model integration (CMMI) program t
hat allows stand-alone basic Part D prescription drug plan (PDP) sponsors to implement innovative MTM services and strategies. 

Ilene Harris, PharmD, PhD, IMPAQ International LLC, explained that beginning in January 2017, six stand-alone basic PDP sponsors, each with their own unique approach, are implementing the enhanced MTM initiative with CMMI in hopes of optimizing medication use, improving care coordination, and strengthening health care system linkages for a 5-year period.

The main differences between standard MTM and enhanced MTM is the power the PDP holds. In the enhanced model, PDPs determine their own criteria, choose enrollment methods, and select services available and eligibility requirements. Standard MTM is just that, standard, defined criteria across the platform. 

After 2 years into monitoring the PDPs model initiatives, data remained consistent that around 60% of enrollees were targeted, 6% to 7% of targeted enrollees had at least one issue with medication therapy, and 25% of hospital-to-home discharges were followed by an MTM service. —Edan Stanley