PerformRx has learned a great deal about medication therapy management (MTM) over the years. Since 2006, we have been providing MTM on behalf of our clients. We were one of the first PBMs to be URAC-accredited for Drug Therapy Management and The American Journal of Managed Care published an article about one of our programs in 2014. To help you develop your MTM program, we have condensed the last nine years of MTM experience into five quick tips.
- The future is now: The Centers for Medicare & Medicaid Services (CMS) release proposed changes that affect MTM and Star Ratings programs well in advance of the due date. While not all of these changes become final, they do provide pharmacy benefit managers (PBMs) and health plans with an opportunity to identify best practices prior to implementation. We suggest identifying sample populations and tweaking programs prior to the deadline. These proactive steps will prove extremely beneficial when the measure goes live.
- So invest in that future: Both the Pharmacy Quality Alliance (PQA) and CMS provide PBMs and plans with opportunities to shape the conversation through membership, workgroups, meetings and comment periods. While the proposed measures are often in members’ best interests, sometimes they need refinement. To help influence regulations that affect you, contribute to these conversations. By commenting and participating, you can ensure the measures make sense for everyone before they affect your organization.
- Aim for the Stars when it comes to CMRs: Comprehensive medication reviews (CMRs) are finally here as a Star Ratings measure. CMRs are interactive reviews of members’ medications performed by a qualified provider. It is important to outreach to as many MTM enrollees as possible — it is estimated that only 1 percent of all Medicare enrollees have received a CMR.
- The human touch: According to a recent Gallup poll, pharmacists are the second most trusted professionals in the United States. As a result, PerformRx has found great success with using pharmacists for each live outreach. In an age of automated outbound calls and voice prompts, people have expressed appreciation for the human element. Offer your members one-on-one access to pharmacists to improve their satisfaction and overall wellbeing.
- Manage your opioid over-users: Members who overuse opioids may have issues with other medications. These problems can range from taking too many medications for one condition to taking high-risk medications, and can include other issues that need monitoring and intervention. Enrolling these members in MTM is a way to improve their overall health while ensuring proper use of opioids.
Dan Horsey is a Marketing Specialist that has been with PerformRx since 2009. He has previous experience in Medicare Part D compliance, pharmacy network management, and retail pharmacy.