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AFTER BEING FORMALLY introduced in 2006 to Part D plans under the Medicare Prescription Drug, Improvement and Modernization
Act of 2003, Medication Therapy Management (MTM) programs have not lived up to their expectations, some experts say.
"The uptake is just not there," says Atheer Kaddis, vice president, managed markets for Diplomat Specialty Pharmacy based
in Flint, Mich., "and those who have developed MTM programs under Part D have just done enough to meet the requirements and
stay in compliance."
Others believe that MTM has exceeded its promise, improving medication safety, achieving appropriate drug utilization and
generating return on investment for PBM clients.
But changes are coming in 2010. Proposed Centers for Medicare & Medicaid Services (CMS) changes for MTM include more lenient
eligibility requirements; an annual, interactive person-to-person comprehensive consultation and medication review; and quarterly,
targeted medication reviews to assess drug use and monitor any problems. According to Kaddis, coordinating care between care managers and those at a plan is key to the success of MTM, He points out
that many programs just focus on polypharmacy and what drugs can be eliminated from a regimen rather than consider quality
of care, side effects and drug interactions.
Diplomat's MTM proprietary software tool, used by its patient-care coordinators and pharmacists, creates standardized questions
for patients about their therapy and disease state once they start taking a specialty drug.
The program uses screening tools for depression, for example, a condition common to patients on complex specialty drugs. In
the case of one particular client, a set of screenings indicated more than 10 patients were at possible risk for suicide,
all of whom also had multiple sclerosis.
The program's design called for a three-way conversation among the patient, physician and care coordinators to determine the
best intervention, which in some cases meant a change in medications to prevent exacerbating depression.
Kaddis says the program caters more to commercial customers so far, but he predicts an increase in Part D patients as more
oncology drugs hit the marketplace.
In another MTM program, Diplomat focuses on chronic kidney disease, which Kaddis says is not usually considered a specialty
condition. He notes, however, that by looking at comorbidities associated with chronic kidney disease, the program can address
comprehensive needs.
He highlights increased access through copayment relief, side-effect management and adherence as the secrets of MTM success.
TECHNOLOGY VS. PERSONAL CONTACT
Other MTM programs that combine technology and high-touch tactics also have proved effective.
For an MTM program to be cost-effective, it must include automated technology to identify patients that will benefit most
from specific interventions, says Kevin Boesen, PharmD, director of the Medication Management Center at the University of
Arizona College of Pharmacy. However, in terms of ensuring that the interventions are appropriate and ultimately implemented,
person-to-person contact with a pharmacist must be built into the program.
Components of a successful MTM program
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"The pharmacist plays a critical role in ensuring the recommendations being suggested by the automated process are valid based
on information not included in the data, such as over-the-counter medications, allergies, medical conditions and prescriptions
paid by cash," he says. "The pharmacist also plays a key role in ensuring the patient understands the recommendation, and
the better the understanding, the more apt the patient is to follow the advice."
Boesen advocates being proactive with patients who can most benefit, instead of waiting for them to accept an invitation to
join an MTM program.
A pharmacist-run call center is the core of the MTM program offered to senior populations under MCOs by the University of
Arizona College of Pharmacy. Boesen says the call center proactively reaches out to plan members to improve adherence to medications,
reduce costs and increase safety.
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