Benefits of CMRs and TMRs in MTM Program

San Antonio—Medicare Part D medication therapy management (MTM) programs are required to include both comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs). CMRs are particularly important to plan sponsors because they will become a Centers for Medicare & Medicaid Services (CMS) Star Ratings performance measure in 2015. However, TMRs also are critical to a successful MTM program because they identify the majority of potential drug therapy problems. During a session at the AMCP meeting, Tim Sullivan, PharmD, RPh, William Doucette, PhD, and Kevin Boesen, PharmD, discussed this topic in a presentation titled Medication Therapy Management: Comprehensive vs Targeted Medication Reviews.

Dr. Sullivan, director of clinical services for OutcomesMTM, opened the session with an update on the growth of MTM. OutcomesMTM was established in 1999 and has been delivering community pharmacy-based MTM services since its inception. The uptake of MTM services by Medicare beneficiaries has grown in recent years. Influential factors leading to growth include: the market recognizing the impact of pharmacists, health plans have become more sophisticated with MTM delivery, and pharmacies have made MTM a mainstay of daily practice.

Drs. Doucette and Boesen presented the results of separate research studies: one focusing on stimulating patient demand for CMRs and the other focusing on the “hidden value” of TMRs.

Dr. Doucette, professor of pharmacy at the University of Iowa College of Pharmacy, presented the findings of a CMR study published in Journal of the American Pharmacist Association in 2013. Dr. Doucette, lead investigator, said the purpose of the study was to identify factors that influence patients’ decision to obtain pharmacist-provided CMRs and describe patients’ experience with pharmacist-provided CMRs. The self-reported mail survey was sent to 713 Medicare beneficiaries who had at least 12 prescription drug claims during a 6-month period. The participants had completed a previous telephone interview for a larger study of quality improvements of an MTM program for 2 Medicare Part D plans.

The results showed that “knowing my out-of-pocket cost for CMRs” (58.7%), “having a pharmacist from my usual pharmacy conduct CMRs” (55.7%), and “having a convenient location for CMRs” (52.5%) as the 3 most important factors on participants deciding to get a CMR. The least important factor was “knowing the amount of time CMRs will take” (31.3%).

Factors that were significantly more important to participants who had CMRs in the previous year compared with those who did not have a CMR in the previous year included “having a pharmacist from my usual pharmacy conduct CMRs” (4.34 vs 3.82, respectively), “having my pharmacist discuss with my physician on possible medication changes” (4.13 vs 3.32, respectively), “having support of my physician to get CMRs” (41vs 3.58, respectively), and “receiving an up-to-date list of my current medication from the pharmacist” (4.08 vs 3.31, respectively).

Furthermore, approximately 30.6% of the survey respondents reported having pharmacist-provided CMRs within the previous year, with 64% receiving CMRs in person. The average time for CMRs was 20.6 minutes. Overall, a majority of the respondents (90.6%) believed that having CMRs was important to their health and 90.6% were satisfied with the results of CMRs.

“Pharmacists can use the study results to better engage patients in the MTM process,” concluded the researchers.

During the final presentation, Dr. Boesen, founder and director of the Medication Management Center (MMC) at the University of Arizona College of Pharmacy, presented the results of a MMC study that sought to determine whether patients who had a CMR had more medication changes than patients who only had TMRs.

The cross-sectional observational study included data collected via MMC’s annual CMS reports and pharmacy claims. He explained that data was combined for 62 CMS annual reports, resulting in 418,649 MMC patients who qualified for the MTM program. The results found that the TMR-only group (n=375,159) represented that vast majority of all changes compared with the CMR group (n=43,490): 90% versus 10%, respectively. There were more prescriber interventions per member in the CMR versus the TMR-only group (0.81 vs 0.68, respectively; odds ratio [OR], 0.70; 95% confidence interval [CI], 0.69-0.72). However, more medication changes per prescriber intervention were observed in the TMR-only group compared with CMR group (0.24 vs 0.23, respectively; OR, 1.24; 95% CI, 1.21-1.28).

“While CMRs are important, significance of TMRs should not be underemphasized,” concluded Dr. Boesen.