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An important role for pharmacy technicians who participate in medication therapy management (MTM) is to develop and maintain documents and paperwork involved in MTM. Pharmacists can focus more efficiently on patient care if they have administrative support from technicians. By starting out with the right types of documents and keeping them up to date, technicians can help to greatly streamline the MTM process.

The forms described in this module are the standard forms recommended by the Centers for Medicare & Medicaid Services (CMS) for MTM services. As shown in Figure 1, the primary documents used in MTM are the Medication List and the To-Do List (formerly known as the Medication Action Plan, or MAP). The most recent CMS update also requires that the patient receive information on safe disposal of unused prescription medications (especially controlled substances).1

Figure 1. CMS-Recommended Documents Used in MTM

1. THE PERSONAL MEDICATION LIST (PML)

This document may be referred to as a Patient-Centered Medical Record (PMR), Patient-Centered Medication List, or other names. Its goal is to provide a user-friendly listing of all the patient's current medications. The Medication List should contain additional information to help the patient take medications correctly, as illustrated in Figure 2.

Figure 2. Essential Information in Personal Medication List

The Medication List is much more patient-specific than the standard drug information handouts the pharmacy usually provides for patients. In most pharmacy settings, a patient would need an MTM consultation in order to receive a document as individualized and comprehensive as the PML.

Sample templates are available for generating an electronic MTM Medication List. The forms may differ depending upon the pharmacy organization. CMS provides a sample fillable template for Medication List in its Standardized MTM Format (Figure 3).2

Figure 3. CMS Template for the MTM Medication List2

Available in the Standardized Format Instructions link at https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.
A sample of a partially filled in Medication List is shown in Figure 4.

Figure 4. Sample Medication List based on CMS Template [fictitious patient]

THE PATIENT'S ROLE IN MAINTAINING THE MEDICATION LIST

In order to be effective, MTM documents must be current, but also optimized to be helpful to the patient. Ideally, the goal is to develop documents and tools that allow patients to take their medications and manage their health conditions with less effort. The CMS MTM format recommends that patients bring the current Medication List to doctors' appointments and other healthcare visits and that they share it with family members and caregivers.

HOW CAN TECHNICIANS HELP TO GENERATE AND UPDATE THE Medication List?

Pharmacy technicians can be involved in generating and updating the Medication List by assisting in the following steps:

  • Assist the pharmacist before or during the initial patient interviews, helping to gather information about what drugs they are using and how they are being used.
  • Fill out the Medication List template before, during, or after an MTM session.
  • Use the information gathered during the patient interview to generate a more accurate list for the pharmacist to review.
  • Verify medications through a second source, such as a caregiver.
  • Update the Medication List as needed if the patient's condition or medications change
  • Provide updated copies to prescribers and other members of the healthcare team
  • Explain to patients how the Medication List can be used

2. THE TO-DO LIST

Another key document used in MTM is the To-Do List. (CMS previously called this document the Therapeutic Action Plan or the Medication Action Plan/MAP.) The aim of the To-Do List is to identify the goals of MTM, including any changes made in medications or other steps recommended to help patients resolve health problems and/or meet specific health objectives. Technicians who participate in MTM should be familiar with the format and purpose of this document, how to incorporate changes or updates, and who should receive copies of the To-Do List.

The To-Do List will be different for every patient, but there are some common assessment points. This checklist, modified for the patient's specific health conditions, can serve as a basis to identify the patient's medication-related problems, adherence problems, and potential health safety issues or behavioral risks. Most of these questions should be assessed by the pharmacist or other MTM provider during the face-to-face MTM interview. Technicians should be aware of these objectives to understand the overall purpose of MTM.

SUMMARIZING THE TO-DO list for THE PATIENT

Goals of the To-Do List include:

  • Help motivate patients to assist in managing their own health
  • Develop practical steps for the patient and healthcare team to follow
  • Identify and correct problems or errors related to medication safety
  • Explore ways to reduce costs: reduce waste, improve adherence, offer less-expensive drug alternatives when possible

The To-Do List may contain steps that may be implemented by the patient, caregivers, or the physician. In some cases, the prescriber or clinician may need to approve or review some changes before the To-Do List can be distributed to the patient.

A sample of the CMS recommended To-Do List Template is shown in Figure 5. The latest, simplified format presents the information to the patient in the following format:

  • What we talked about (during MTM)
  • What I should do
Figure 5. CMS To-Do List Template2
Available in the Standardized Format Instructions link at https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm

A sample of a partially filled in To-Do List is shown in Figure 6.

Figure 6. Sample To-Do List based on CMS Template [fictitious patient]

TO-DO LIST FOLLOW-UP

MTM should not be a one-time process. Follow-up, or continuity of care, is especially important for helping patients to manage chronic disease. Giving patients positive steps or goals may encourage them to return for follow-up visits. A person who is not engaged in the process—or who does not believe he or she has gained any benefit from MTM—is less likely to return for follow-up.

Technicians can serve essential roles in ensuring follow-up with MTM, as outlined in the diagram in Figure 7.

Figure 7. Pharmacy Technicians' Roles in MTM Follow-up

DOCUMENTATION TIPS

Documentation is an essential part of MTM. In addition to providing information for the patient, records of the MTM process must be generated for the pharmacy and for other healthcare providers. MTM encounters are usually documented using software provided by the pharmacy. Ideally, this documentation would automatically be transferred to the patient's Electronic Health Record (EHR) where updates would be visible for all providers. Unfortunately, not every system is equipped with effective EHRs. Sometimes, documents must be exchanged between physicians' offices or hospitals via fax or secure email.

SAFE DISPOSAL OF MEDICATIONS

A newer recommendation of CMS is that patients who participate in MTM should receive information from the MTM provider about how to safely dispose of unused medications. The need to dispose of medications arises because the MTM process often identifies drugs that the patient no longer needs, or results in a change of medication or dose. Safe disposal is especially important for controlled substances. More detail on safe disposal is provided in Module 4, Medication Safety, in this program.

SUMMARY AND CONCLUSIONS

The Medication List and To-Do List are standard parts of most MTM services. Generating printed lists with a lot of information and handing them over to the patient is unlikely to achieve the goals of MTM. Directions should be presented in ways that are clear, concise, and easy for the patient to use. Follow-up with healthcare providers to document any decisions made during MTM is vital to the process of health information exchange among providers. Pharmacy technicians are an essential part of the documentation process. Pharmacists and technicians who engage in MTM should evaluate existing documents and determine how they can be adapted to advance the MTM process.

REFERENCES

  1. Centers for Medicare & Medicaid Services (CMS). Contract Year 2024 Medication Therapy Management Program Guidance and Submission Instructions. April 21, 2023. Available at: https://www.cms.gov/files/document/memo-contract-year-2024-medication-therapy-management-mtm-program-submission-v042123.pdf.
  2. Centers for Medicare & Medicaid Services (CMS). Revised MTM Program Standardized Format. Form CMS-10396. Expires: 02/29/2024. Available at: https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/mtm.

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