Medication Therapy Management (MTM) Services Improve Outcomes and Reduce Costs
By David Chojnacki, Chief Revenue Officer at Verifi1
FEBRUARY 19, 2018
There is almost universal concurrence when they were originally implemented – over four decades ago – that most pharmacy benefit managers (known commonly by the acronym of “PBM’s”) did help to mitigate some of the pharmacy expense issues that were previously unchecked. At the time, their primary purpose was to assure that only eligible members receive prescription benefits and that the pharmacy charges for those benefits were reasonable and accurate. Initially, these simple checks on pharmacy claims provided significant decreases in prescription costs during a period in which healthcare was rendered in a far less complex fashion than exists today.
Over the years drug therapy has become more complex and more expensive. Cost increases are now due to both the unit cost of the drug and the manner in which therapy is utilized. Drug utilization has become equally (if not more) important in prescription cost trend. While the PBM industry has attempted to repurpose its tools (through prior authorizations, step edits, formularies, and special distribution channels like mail order and specialty drugs) these efforts have merely “nibbled away” at unit cost - but left utilization largely untapped. Additionally, these tools cannot be used in certain therapeutic areas as they create too much disruption for patients attempting to access needed and appropriate drug therapy services.
In medication therapy management (MTM), a pharmacist can work with a patient's physician (or group of physicians) to develop a comprehensive program of drug therapy.
Often, this is the result of eliminating, adding or switching medications, and in most instances, ends up saving the patient - and payor - money and, more importantly, improving the patient's overall health. In a nutshell, medication therapy management (MTM) has proven to be a useful tool for optimizing drug therapy and, in turn, tempering the utilization component of drug cost trend. MTM engages both prescribers and patients (when necessary) in a review of medication use behavior to minimize inappropriate and legacy therapy. This process reduces drug and drug cost burden for both payor and patients with no disruption to appropriate therapy access at the point of service.
To learn more about how medication therapy management can help your organization build a cost-effective care program by seamlessly connecting patients, pharmacists and providers to identify, prevent and resolve medication-related problems, contact Verifi1 at 248-562-6308.