Medication therapy management, commonly known as MTM, is a CMS requirement for health plans that offer a Medicare Part D benefit. Originally introduced a few decades ago under the term “pharmaceutical care”, MTM has grown dramatically from a box to be checked into a highly influential clinical service that can play a massive role in creating improved health outcomes for health plan members.
It’s defined by the American College of Clinical Pharmacy as a “range of services provided to individual patients to optimize therapeutics outcomes and detect and prevent costly medication problems”.
Despite recent updates from the Centers for Medicare and Medicaid Services (CMS) that have made the comprehensive medication review completion rate into a display measure rather than a Star measure for 2025 and 2026, health plans can’t let MTM fall off their radar. With vastly increasing MTM eligibility coming soon, now is the time to bolster MTM program quality and capacity ahead of a CMR surge.
Let’s dive deeper into MTM’s goals, how it’s delivered, and how health plans can create MTM plans that move the needle toward enhancing their members’ well-being.
Goals of medication therapy management
At their core, MTM services are intended to optimize medication use in patients, leading to better health outcomes and prevention of medication-related issues before they have a chance to occur. It’s the proactive nature of MTM that creates the conditions necessary for pharmacists to uncover hidden or overlooked medication errors that could lead to potentially harmful situations if allowed to persist.
Reduces duplicative medications
One way in which MTM helps improve outcomes and efficiency in our healthcare system is by reducing the amount of wasted medication. During a comprehensive medication review (CMR), a pharmacist reviews a patient’s entire medication list, including all prescriptions, over-the-counter medications, and even herbal supplements.
During this review, pharmacists often discover that patients may be taking duplicative medications due to changes in care settings, noncommunicative prescribers, or simple human error. Regardless of cause, these duplicative medications can be extremely dangerous if not detected and corrected under the watchful care of a clinical pharmacist.
One of the most common ways that a duplicative medication situation may present itself is through the combination of prescription and over-the-counter medications that include the same active ingredients. An example of this situation would be taking an over-the-counter acetaminophen dose to lower a fever while sick at the same time as a cold medication that also contains acetaminophen. This duplicative dosing of the same active ingredient can create accidental overdoses that result in harmful health effects, in this case, potential liver damage.
During a CMR, because pharmacists review the entire medication list including prescriptions and OTC drugs, this duplicative dosing would be discovered, and the pharmacist would be able to educate the patient on the potential harm while offering advice on alternative medications that are safe to take in conjunction with each other. Critically, this is an error that might be missed by a physician because neither medication in the example is a prescription. That’s exactly why the comprehensive nature of MTM allows more errors to be caught, identified, and corrected. H3 Empowers health plan members
One of MTM’s greatest benefits is the ability it has to empower health plan members through medication education. In a healthcare landscape full of increasingly complex medications and out-of-control prices, it’s more critical than ever for health plan members, especially Medicare beneficiaries, to be educated on their health so they can make the right decisions for themselves.
A critical part of this health literacy is getting education from expert clinicians in an empathetic way. That’s where pharmacists come in. During an MTM consultation, the pharmacist can help the member understand each medication in their regimen, why it was prescribed, how to take it properly, how it may interact with their other medications, and answer any other questions that arise during the conversation.
It’s through education from pharmacists that health plan members can begin to take a more active role in the maintenance of their own health. Having the knowledge and understanding of their medications and how they work to improve their health conditions is invaluable and can lead to improved medication adherence and long-term successes in treatment and condition management.
Reduces side effects from medications
MTM is also an important way to reduce the medication-related side effects suffered by health plan members. During a comprehensive medication review, one of the key areas pharmacists focus on is understanding how the member is tolerating their medications, any negative effects they’re experiencing, and making recommendations on how to correct any such issues.
When Aspen RxHealth pharmacists uncover negative side effects in their patients, they document them through the easy-to-use pharmacist platform, and are then able to engage the patient’s prescribing provider and/or health plan to make recommendations for alternative medications or plans to optimize the patient’s medication regimen.
Creating an MTM program for enhanced member outcomes
It’s clear that MTM programs can produce immense value both for members’ health, but also through health plans through the cost avoidance associated with improved condition management and proactive interventions.
Despite a temporary pause on MTM influencing Star Ratings in 2025 and 2026, what can health plans do now to ensure that they’re prepared for increased MTM eligibility volumes?
Find the right MTM partner
There’s a wide world of healthcare vendors who claim they can help your health plan improve its MTM programs, so it’s important to find the right MTM partner to meet your needs.
When vetting potential vendors, it’s critical to understand their experience, technology platform, reporting offerings, and service model. At Aspen RxHealth, we’re proud to say we were founded by pharmacists who understand the value of pharmacist expertise. Not only that, but our technology platform handles all documentation, scripting, and post-consultation follow-up. Finally, our clients have access to an on-demand reporting suite for an in-depth look at program performance.
Harness the power of pharmacists
Some programs are staffed by pharmacy technicians or pharmacy students. While pharmacy technicians have an important role to play in our healthcare system, they cannot replace the medication expertise that only licensed pharmacists have.
Aspen RxHealth’s MTM programs provided to our clients are exclusively delivered by licensed pharmacists. With a gig-economy workforce of thousands of pharmacists across the United States, there’s no member population we can’t reach to deliver high-quality clinical consultations.
Properly equip your pharmacists
With all their knowledge and expertise, pharmacists are still only as good as the tools they’re equipped with. If you’re using a team of in-house pharmacists who already work for your health plan, it’s critical to pay special attention to the MTM software platform they’re using.
Is it intuitive?
Does it manage all documentation?
Is the telephony platform built in?
When you empower your pharmacy team with Alliance by Aspen RxHealth, you can answer all the questions above with a resounding “yes”. Alliance by Aspen RxHealth allows your plan’s pharmacists to leverage our award-winning platform to deliver clinical pharmacy services such as MTM with greater efficiency than ever before.
As you prepare your health plan to address the brave new world of MTM following the recent updates from CMS, keep in mind that the next few years will represent a massive increase in MTM eligibility, followed by a renewed necessity for MTM completion rates to achieve Star Rating goals, starting in 2027.
Whether your health plan is comprised of MTM pros who have been delivering the service for years and need a new platform, or has never provided MTM before and needs a partner, Aspen RxHealth stands ready to help. Drop us a line to explore how we can help you meet your goals.