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Medical Providers

Medications Therapy Management

What is Medication Therapy Management (MTM)?

Medication therapy management, also referred to as MTM, is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team.

Why is it important to you as a Medical Provider?

Medication Therapy Management accomplishes two major goals that affect your practice: First, it helps mitigate medical errors and conflicts and/or overlap in medication therapy across prescribers. Second, it provides an opportunity to review the medications provided for adherence to formularies and provide alternatives to control cost.

What is involved in Medication Therapy Management?

As defined in a consensus definition adopted by the pharmacy profession in 2004, medication therapy management is a service or group of services that optimize therapeutic outcomes for individual patients. Medication therapy management services include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and many other clinical services. Pharmacists provide medication therapy management to help patients get the best benefits from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems.

Why is Medication Therapy Management needed?

Medication-related problems and medication mismanagement are a massive public health problem in the United States. Experts estimate that 1.5 million preventable adverse events occur each year that result in $177 billion in injury and death.

Where is Medication Therapy Management provided?

Pharmacists provide medication therapy management services in all care settings in which patients take medications. While pharmacists in different settings may provide different types of medication therapy management services, the goal of all pharmacists providing medication therapy management is to make sure that the medication is right for the patient and his or her health conditions and that the best possible outcomes from treatment are achieved.

Who can benefit from Medication Therapy Management?

Anyone who uses prescription medications, non-prescription medications, herbals, or other dietary supplements may potentially benefit from medication therapy management services. People who may benefit the most include those who use several medications, those who have several health conditions, those who have questions or problems with their medications, those who are taking medications that require close monitoring, those who have been hospitalized, and those who obtain their medications from more than one pharmacy.

Prior Authorizations

Prior Authorizations (PA) can be a tedious and complicated process for both patients and their caregivers. As medical providers, you want to ensure that your patients get their medications in a timely fashion. Our staff can facilitate the process of filing the proper paperwork and following up with the insurance companies to obtain the authorizations and fill your patient’s prescriptions.

Prior Authorization is usually required for medications that are:

– Subject to overuse, misuse or off-label use
– Limited to specific patient population
– Subject to significant safety concerns
– Used for condition that are not included in the pharmacy benefit, such as cosmetic uses
– Expensive

Our staff understands the criteria insurance companies use when providing Prior Authorizations, the documentation needed to successfully obtain them, and how to navigate the bureaucracy to finalize the process quickly and effectively.

Star Ratings

Medicare plans are focusing more than ever on medication adherence to measure the quality of the service healthcare providers deliver to their members. As such, ensuring that your patients are filling their prescriptions is a must. Sunset Drugs has the tools necessary to track and report the data needed for compliance with all pharmacy-related quality measures.

What are Star Ratings (Quality Ratings)?

Medicare uses a Star Rating System to measure how well Medicare Advantage and prescription drug (Part D) plans perform. Medicare scores how well plans did in several categories, including quality of care and customer service. Ratings range from 1 to 5 stars, with five being the highest and one being the lowest score. Medicare assigns plans one overall star rating to summarize the plan’s performance as a whole. Plans also get separate star ratings in each individual category reviewed. The overall star rating score provides a way to compare performance among several plans. To learn more about differences among plans, look at plans’ ratings in each category.

Medicare reviews plan performances each year and releases new star ratings each fall. This means plan ratings change from one year to the next. Medicare sets the categories and reviews each plan the same way. You should look at coverage and plan costs, such as if the Part D plan covers all the drugs you take and has a premium you can afford before you consider the star rating.

Medicare health plans are rated on how well they perform in five different categories:

1. Staying Healthy: Screenings, Tests, and Vaccines
2. Managing Chronic (Long-Term) Conditions
3. Plan Responsiveness and Care
4. Member Complaints, Problems Getting Services, and Choosing to Leave the Plan
5. Health Plan Customer Service

Medicare drug plans are rated on how well they perform in four different categories:

1. Drug Plan Customer Service
2. Member Complaints, Problems Getting Services, and Choosing to Leave the Plan
3. Member Experience with Drug Plan
4. Drug Pricing and Patient Safety

Compounding

More and more people have unique health needs that mass-produced prescription medicines cannot meet. For them, customized, compounded medications prescribed by their physicians and expertly mixed by trained, licensed compounding pharmacists are a viable alternative.
Our Pharmacy Maintains Best Practices and Standard Operating Procedures for a compounding pharmacy to further ensure the highest quality and caliber of medicine that is customized in our labs.

Personal preferences are taken into account so that we may be able to create:

  • A medication for a patient that is no longer commercially available.
  • Flavored medication either in a suspension format or even “lollipops” allowing the patient to swallow the medicine without the bitter taste
  • Attention to excipients that may harm or cause an adverse reaction in our patients such as sugar, gluten, lactose, alcohol, or dyes; and
  • Ability to combine compatible medications into one dosage format for easier ingestion.

Specialty Medications

Specialty Medications can be very expensive and hard to find. Sunset Drugs can obtain many Specialty Drugs that are hard to obtain or too expensive for most pharmacies to keep in inventory. If your practice regularly prescribes Specialty Medications, we can keep an inventory for your patients.

What are Specialty Medications?

A specialty medical benefit drug is typically given as an injection or infusion in the member’s home, physician’s office, or outpatient facility. Specialty medical drugs meet certain criteria including, but not limited to:

– The drug is used in the treatment of a rare, complex, or chronic disease;
– A high level of involvement is required by a health care provider to administer the drug;
– Complex storage and/or shipping requirements are necessary to maintain the drug’s stability;
– The drug requires comprehensive patient monitoring and education by a health care provider regarding safety, side effects, and compliance; and
– Access to the drug may be limited.