The document discusses medication therapy management (MTM) services and developing an MTM practice. It defines MTM as patient care services established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The core elements of an MTM service model are identified as medication therapy review, personal medication record, medication-related action plan, intervention/referral, and documentation/follow-up. Additionally, the document discusses current MTM legislation, skills needed for MTM, and how to become an MTM provider through needs assessment, SWOT analysis, service planning, financial justification, payment, and program evaluation.

1. Development of a Pharmacy
Business (MTM)
Chelsea Shipman
Souhanda Sefin
Wesley Singleton

2. What Is Medication Therapy
Management?
• MTM services, or programs, are patient care services that were
established by the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003.
• Creating and maintaining a successful MTM practice
necessitates a culture change where staff training, workflows,
and processes revolve around delivery of a service as opposed
to delivery of a product such as prescription medications.

3. Core Elements of an MTM Service Model
in Pharmacy Practice
The MTM service model in pharmacy practice includes the
following five core elements:
• Medication therapy review (MTR)
• Personal medication record (PMR)
• Medication-related action plan (MAP)
• Intervention and/or referral
• Documentation and follow-up

4. Medication Therapy Review
• The medication therapy review (MTR) is a systematic process of collecting
patient-specific information, assessing medication therapies to identify
medication-related problems, developing a prioritized list of medication-
related problems, and creating a plan to resolve them.
Personal Medication Record
• The personal medication record (PMR) is a comprehensive record of the
patient’s medications (prescription and nonprescription medications, herbal
products, and other dietary supplements).

5. Medication-Related Action Plan
• The medication-related action plan (MAP) is a patient-centric
document containing a list of actions for the patient to use in
tracking progress for self-management.
Intervention and/or Referral
• The pharmacist provides consultative services and intervenes to
address medication-related problems; when necessary, the
pharmacist refers the patient to a physician or other healthcare
professional.

6. Documentation and Follow-up
MTM services are documented in a consistent manner, and a follow-up
MTM visit is scheduled based on the patient’s medication-related needs, or
the patient is transitioned from one care setting to another.

7. Current Atmosphere of MTM
Services
Quality Measures
• Though current pharmacy practice models do involve provision of some patient care
services, the majority are tied to the product.
• Counseling on a medication the patient is picking up is a prime example of this, as the
patient may view receiving the product as the primary goal of visiting the pharmacy
and counseling as an adjunctive service.
• Product centered workflows and behaviors create a discrepancy between where the
profession wants to go (i.e. service centered) and where pharmacy practice remains
rooted.

8. Legislation in MTM Services
• The Medicare Drug Benefit is commonly known as Medicare Part D. The Centers for Medicare and
Medicaid Services (CMS) require plan sponsors, such as prescription drug benefit managers or
Medicare Advantage organizations, to develop and administer MTM programs.
• Requirements for Medication Therapy Management Programs (MTMP): Under 423.153(d), a Part D
sponsor must have established a MTM program that:
• Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use
• Reduces the risk of adverse events
• Is developed in cooperation with licensed and practicing pharmacists and physicians
• Describes the resources and time required to implement the program if using outside personnel and establishes
the fees for pharmacists or others
• May be furnished by pharmacists or other qualified providers
• May distinguish between services in ambulatory and institutional settings
• Is coordinated with any care management plan established for a targeted individual under a chronic care
improvement program (CCIP)

9. Payers
Medicare Part D payers are required to cover MTM services for eligible patients.
After identifying and contracting with Medicare Part D plans, a consultation with
each payer should be done to determine how MTM services should be billed. The
most common scenarios for provision of Medicare Part D MTM services are the
following:
• The payer (Medicare Part D plan) uses its own employee pharmacists to
provide MTM and does not contract for the services.
• The payer contracts with pharmacies or individual pharmacists to provide the
services.

10. https://www.youtube.com/watch?v=NevLYzsG2Y8

11. MTM Skills
• Strong verbal and written
communication skills
• Listening skills
• Ability to work on a team
• Ability to question patients
• Empathy
• Independent thinker
• Dependable
• Evaluating medication regimens
• Identifying medication-related problems
• “Making recommendations to patients, caregivers,
and healthcare professionals”
"Delivering Medication Therapy Management Services." American Pharmacists
Association. American Pharmacists Association, 17 Mar. 2012. Web. 17 Apr. 2016.
Pharmacist: Medication Therapy Management Communication and Care Center.
University of Florida Human Resource Services, 17 Apr. 2016. PDF.

12. Becoming a MTM provider
• Planning is a multistep process
• Create an Business Plan
• Executive Summary
• Business Profile
• Services
• Marketing Analysis and Plan
• Operations and Management
• Financials Assessment
• Conclusion

13. Needs Assessment
• The first and most important step to planning
• For the needs assessment, there are three basic questions to ask:
• What is the patient need or problem to be addressed?
• How large is this problem, and what are the trends?
• How well are the patient needs currently being addressed?

14. What is the patient need or problem to be
addressed?
• Primary Information
• interview
• Survey
• Observations
• Patient records
• Secondary Information
• Literature articles
• Continuing education programs
• Research databases

15. How large is this problem, and what are the
trends?
• Primary Research
• Secondary Research
• Patient trends
• Incidences
• Medical outcomes
• Disease prevalence or complications

16. How well are the patient needs
currently being addressed?
• Physicians
• Nurses
• Pharmacists
• Pharmacy benefit management
companies
• Need assessment grids

17. SWOT Analysis
A critical evaluation of the internal and external factors that may
affect the success of a pharmacy service is needed
• Strength
• Weakness
• Opportunities
• Threats

18. Service Planning
• Mission and vision statements
• Goals of the services
• Manage Diabetes Patients
• Reduce Patient Hypertension
• Educate HIV and AIDS patients

19. Organizational Structure
• Organizational Hierarchy Outline
• Staffing
• Rules and Guidelines of Operation
• Policies and Procedures
• Documentation
• “SOAP” method

20. Financial Justification
• Cost avoidance (ex. Hospitalizations, surgery)
• Increase Revenue
• Financial analysis
• Cash flow and startup costs
• Break-even analysis
• Sensitivity analysis
• Back of the envelope (BOE) analysis

21. Payment• Gross margin from dispensing prescriptions
• Medicare Part B
• Immunization
• Durable medical equipment
• Outpatient diabetes management training
• Laboratory tests via Clinical Laboratory Improvement Amendments (CLIA)
waiver
• Collaborative practice agreement
• Medicare Part D

22. Billing Models
• Direct Billing
• Pharmacist viewed as provider
• Indirect Billing
• “Incident to physician billing” or
“backdoor”
• Collaborative practice agreement
• New Billing Methods
• Patient Centered Medical Home
(PCMH)
• Accountable Care Organization
(ACOs)
• First or Third Party Payer
• Medicare B
• Medicare D
• Private Insurance
• Patient
• Common Average Billing Payments
• $26.58 ($1/min)
• $53.16 ($2/min)
• $79.72 ($3/min)

23. Program Evaluation
• Economic Outcomes
• Clinical Outcomes
• Humanistic Outcomes

24. FLORIDA & HIV/AIDs
FLORIDA DEPARTMENT OF HEALTH DIVISION OF DISEASE CONTROL AND
HEALTH PROTECTION HIV/AIDS Surveillance Program 2016

25. HIV/AIDS One Stop
Shop.

26. HIV/AIDS One Stop Shop.
Executive summary
• HIV/AIDS are one of the most common diseases being treated today.
However besides treatment, patients also need counseling.
• Only 25% of HIV patients are virally suppressed HOSS is a facility where
HIV/AIDs infected patients can go and receive total care
• The mission HOSS is to create a company where HIV/AIDS will be
acknowledged and discussed in every asset and the patient can go and
receive complete care without fear of embarrassment.

27. Objective & Mission
• HOSS is a facility where HIV/AIDs infected patients can go
and receive total care
• The mission HOSS is to create a company where HIV/AIDS
will be acknowledged and discussed in every asset and the
patient can go and receive complete care without fear of
embarrassment.

28. Key to success
• Making sure each patient is taking his or her medication on
time and as directed. Compliance
• Providing coping mechanism and counseling outlets
• Patient education on the disease and all its phases.

29. Services
• Patient counseling,
• Medication therapy review (MTR)
• Prescription pick up
• Fast
• On the go service
• Convenient
• Knowledge
• Counseling

30. Marketing Analysis
• Strengths:
• Three experienced pharmacist students
• Weaknesses:
• New company
• Small staff
• Opportunities:
• Decrease rates of secondary infection
• Improve patient adherence
• Threats:
• Walgreens, HIV MTM service
• Big Bend Cares

31. Quiz Time…

32. 1. Core elements of MTM include all of the following except.
A. Medication therapy review (MTR)
B. Personal medication review(PMR)
C. Medication-related action plan (MAP)
D. Intervention and/or referral
E. Documentation and follow-up

33. 2. What is Medicare Drug benefit commonly known as?
A. Medicare Part D
B. Medicare Part B
C. Medicare Part C
D. Medicare

34. 3. What are MTM skills?
A. Strong verbal and written communication skills
B. Listening skills
C. Ability to work on a team
D. Ability to question patients
E. All of the Above

35. 4. What Does SWOT stand for?
A. Services, weakness, opinions, threats
B. Strength, weakness, opportunities, threats
C. Strength, welfare, opinions, threats
D. Services, welfare, opportunities, threats

36. 5. Which of the following is considered First or Third
Party Payer?
A. Medicare A
B. Pharmacy
C. Private Insurance
D. Doctor

37. References
• American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in
community pharmacy practice: core elements of an MTM service (version 1.0). J Am Pharm Assoc. 2005;45:573-9.
• Peterson, Sara Lynn, PharmD. "Transitioning Community Pharmacies to a Service Centered Model: A Key Factor for MTM
Success." Pharmacy Practice (n.d.): n. pag. Web. 17 Apr. 2016.
• "Medication Therapy Management." - Centers for Medicare & Medicaid Services. Federal Government, 3 Feb. 2016. Web. 17
Apr. 2016.
• Analysis of pharmacist charges for medication therapy management services in an outpatient setting. Michelle M. Zingone,
Karen E. Malcolm, Stephanie W. McCormick, Kristir R. Bledsoe. Am J Health Syst Pharm. 2007 September 1; 64(17): 1827–
1831. doi: 10.2146/ajhp060438
• "Delivering Medication Therapy Management Services." American Pharmacists Association. American Pharmacists
Association, 17 Mar. 2012. Web. 17 Apr. 2016.
• Pharmacist: Medication Therapy Management Communication and Care Center. University of Florida Human Resource
Services, 17 Apr. 2016. PDF.
• Monthly Surveillance Report: Hepatitis, HIV/AIDS, STD and TB. Florida Department of Health Division of Disease Control
and Health Protection HIV/AIDS Surveillance Program. Florida Health, 10 Mar. 2016.