Medication Therapy Management in Pharmacy Practice: Core Elements of An MTM Service Model

Medication Therapy
Management in
Pharmacy Practice
Core Elements of an
MTM Service Model
Version 2.0 March 2008
March 2008
Medication Therapy Management
in Pharmacy Practice:
Core Elements of an MTM
Service Model
Version 2.0
Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0
A joint initiative of
the American Pharmacists Association and
the National Association of Chain Drug Stores Foundation
Acknowledgment
The American Pharmacists Association and the National Association of Chain Drug Stores Foundation
respectfully acknowledge the contributions of all individuals and organizations that participated in the
development of Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service
Model Version 2.0 document for application across the pharmacy profession.
This service model is supported by the following organizations:

Academy of Managed Care Pharmacy
American Association of Colleges of Pharmacy
American College of Apothecaries
American College of Clinical Pharmacy
American Society of Consultant Pharmacists
American Society of Health-System Pharmacists
National Alliance of State Pharmacy Associations
National Community Pharmacists Association
© 2008 American Pharmacists Association and National Association of Chain Drug Stores Foundation.
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without prior permission of the American Pharmacists Association and the
National Association of Chain Drug Stores Foundation, with the sole exception that Appendices C and D may be reproduced,
stored, or transmitted without permission.
1
Preface
Eleven national pharmacy organizations achieved consensus on a definition of medication therapy management (MTM)
in July 2004 (Appendix A). Building on the consensus definition, the American Pharmacists Association and the National
Association of Chain Drug Stores Foundation developed a model framework for implementing effective MTM services in a
community pharmacy setting by publishing Medication Therapy Management in Community Pharmacy Practice: Core Ele-
ments of an MTM Service Version 1.0. The original version 1.0 document described the foundational or core elements of
MTM services that could be provided by pharmacists across the spectrum of community pharmacy.1
Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0 is an
evolutionary document that focuses on the provision of MTM services in settings where patients* or their caregivers can
be actively involved in managing their medications. This service model was developed with the input of an advisory panel
of pharmacy leaders representing diverse pharmacy practice settings (listed in Addendum). While adoption of this model
is voluntary, it is important to note that this model is crafted to maximize both effectiveness and efficiency of MTM service
delivery across pharmacy practice settings in an effort to improve continuity of care and patient outcomes.
*In this document, the term patient refers to the patient, the caregiver, or other persons involved in the care of the patient.
Notice: The materials in this service model are provided only for general informational purposes and do not constitute business or legal
advice. The National Association of Chain Drug Stores Foundation and the American Pharmacists Association assume no responsibility for
the accuracy or timeliness of any information provided herein. The reader should not under any circumstances solely rely on, or act on the
basis of, the materials in this service model. These materials and information are not a substitute for obtaining business or legal advice in the
appropriate jurisdiction or state.
The materials in this service model do not represent a standard of care or standard business practices. This service model may not be
appropriate for all pharmacists or pharmacies. Service programs should be designed based on unique needs and circumstances and model
examples should be modified as appropriate.
Nothing contained in this service model shall be construed as an express or implicit invitation to engage in any illegal or anticompetitive
activity. Nothing contained in this service model shall, or should be, construed as an endorsement of any particular method of treatment or
pharmacy practice in general.
2
March 2008
Introduction Services’ expectations, as stated in the Medicare Prescrip-
tion Drug, Improvement, and Modernization Act of 2003,
Medication Therapy Management in Pharmacy Practice: that MTM services will enhance patients’ understanding of
Core Elements of an MTM Service Model Version 2.0 is appropriate drug use, increase adherence to medication
designed to improve collaboration among pharmacists, therapy, and improve detection of adverse drug events.8
physicians, and other healthcare professionals; enhance
communication between patients and their healthcare MTM programs are demonstrating positive clinical,
team; and optimize medication use for improved patient economic, and humanistic outcomes across diverse patient
outcomes. The medication therapy management (MTM) populations in various patient care settings.9–15 MTM
services described in this model empower patients to take services are currently being delivered in both the public and
an active role in managing their medications. The services private sectors. In the public sector, some state Medicaid
are dependent upon pharmacists working collaboratively and Medicare Part D plans have focused on a comprehen-
with physicians and other healthcare professionals to sive medication therapy review as the foundation of their
MTM programs. Pharmacists participating in these
optimize medication use in accordance with evidence-
based guidelines.2,3 programs often provide patients with an initial compre-
hensive assessment and ongoing follow-up assessments to
MTM services,* as described in this model, are distinct from identify and resolve medication-related problems.11, 16–20
medication dispensing and focus on a patient-centered, In the private sector, MTM programs are beginning to
rather than an individual product-centered, process of emerge nationwide, offering MTM services to traditional
care.4 MTM services encompass the assessment and evalu- insured groups, managed-care populations, self-insured
ation of the patient’s complete medication therapy regimen, employers, and self-paying individual patients.9,10,12
rather than focusing on an individual medication product.
This model framework describes core elements of MTM Any patient who uses prescription and nonprescription
service delivery in pharmacy practice and does not medications, herbal products, or other dietary supple-
represent a specific minimum or maximum level of all ments could potentially benefit from the MTM core elements
services that could be delivered by pharmacists.5 outlined in this model. As part of the effort to effectively
address the urgent public health issue of medication-related
Medication-related problems are a significant public health morbidity and mortality, MTM services should be considered
issue within the healthcare system. Incidence estimates for any patient with actual or potential medication-related
suggest that more than 1.5 million preventable medication- problems, regardless of the number of medications they
related adverse events occur each year in the United use, their specific disease states, or their health plan cover-
States, accounting for an excess of $177 billion in terms of age. Although MTM program structure and the needs of
medication-related morbidity and mortality.6,7 The Institute individual patients may vary, the use of a consistent
of Medicine advocates that healthcare should be safe, and recognizable framework for core MTM services, as
effective, patient-centered, timely, efficient, and effective to described in this model, will enhance their efficient delivery
meet patients’ needs and that patients should be active and effective quality measurement. As new opportunities
participants in the healthcare process to prevent medica- arise, pharmacists in all practice settings must share a
tion-related problems.3,7 common vision for patient-centered MTM services that
MTM services, as described in this service model, may help improve medication therapy outcomes and provide value
address the urgent public health need for the prevention of within our nation’s healthcare system.
medication-related morbidity and mortality.3 MTM services
may contribute to medication error prevention, result in
improved reliability of healthcare delivery, and enable
patients to take an active role in medication and healthcare
self-management.7 The MTM services outlined in this model
are aligned with the Centers for Medicare & Medicaid
*MTM services are built upon the philosophy and process of pharmaceutical care that was first implemented in pharmacy practice in
the early 1990s. As pharmacy education, training, and practice continue to evolve to a primarily clinical “patient-centered” focus,
pharmacists are gaining recognition from other healthcare professionals and the public as “medication therapy experts.” Recognizing
the pharmacist’s role as the medication therapy expert, the pharmacy profession has developed a consensus definition for medication
therapy management and is increasingly using this term to describe the services provided by pharmacists to patients.
3
Framework for Pharmacist-Provided The Delivery of MTM Services
by the Pharmacist
MTM Services
Within the MTM core elements service model, the patient
This framework for MTM service delivery in pharmacy receives an annual comprehensive medication therapy
practice is designed to facilitate collaboration among the review and additional medication therapy reviews accord-
pharmacist, patient, physician, and other healthcare profes- ing to the patient’s needs. The patient may require ongoing
sionals to promote safe and effective medication use and monitoring by the pharmacist to address new or recurring
achieve optimal patient outcomes. MTM services in all patient medication-related problems.
care settings should include structures supporting the estab-
lishment and maintenance of the patient–pharmacist The total number of reviews required to successfully manage
relationship. a patient’s therapy will vary from patient to patient and will
be ultimately determined by the complexity of the individual
Providing MTM Services in Various Patient patient’s medication-related problems. The extent of health
Care Settings plan benefits or other limitations imposed by the patient’s
payer may affect coverage for MTM services; however, this
Patients with a potential need for MTM services can be iden- would not preclude additional services provided by the phar-
tified by the pharmacist, the physician or other healthcare macist for which the patient pays on a fee-for-service basis.
professionals, the health plan, or the patients themselves
when medication-related problems are suspected. Appendix To perform the most comprehensive assessment of a
B provides considerations for identification of patients who patient, personal interaction with direct contact between
may benefit from MTM services. Patients may be especially a healthcare professional and a patient is optimal. A
vulnerable to medication-related problems during transitions face-to-face interaction optimizes the pharmacist’s ability
of care* such as when their healthcare setting changes, to observe signs of and visual cues to the patient’s health
when they change physicians, or when their payer status problems (e.g., adverse reactions to medications, lethargy,
changes. These transitions of care often result in medication alopecia, extrapyramidal symptoms, jaundice, disorientation)
therapy changes that may be due to changes in the patient’s and can enhance the patient–pharmacist relationship.22 The
needs or resources, the patient’s health status or condition, pharmacist’s observations may result in early detection of
or formulary requirements. It is important that systems be medication-related problems and thus have the potential to
established so that pharmacist-provided MTM services can reduce inappropriate medication use, emergency depart-
focus on reconciling the patient’s medications and ensuring ment visits, and hospitalizations. It is recognized, however,
the provision of appropriate medication management dur- that alternative methods of patient contact and interaction
ing transitions of care. such as telephonic may be necessary for those patients
for whom a face-to-face interaction is not possible or not
For ambulatory patients, MTM services typically are offered desired (e.g., homebound patients) or in pharmacy prac-
by appointment but may be provided on a walk-in basis. tice settings in which the pharmacist serves in a consultative
MTM services should be delivered in a private or semi- role on the healthcare team. Irrespective of whether the
private area, as required by the Health Insurance Portability MTM service is provided by the pharmacist to the patient
and Accountability Act, by a pharmacist whose time can be face-to-face or by alternative means, the service is intended
devoted to the patient during this service.21 In other patient to support the establishment and maintenance of the
care settings (e.g., acute care, long-term care, home care, patient–pharmacist relationship.
managed care), the environment in which MTM services are
delivered may differ because of variability in structure and
facilities design. Even so, to the extent MTM core elements
are implemented, a consistent approach to their delivery
should be maintained.
*Examples of transitions of care may include but are not limited to changes in healthcare setting (e.g., hospital admission, hospital to
home, hospital to long-term care facility, home to long-term care facility), changes in healthcare professionals and/or level of care
(e.g., treatment by a specialist), or changes in payer status (e.g., change or loss of health plan benefits/insurance).
4
March 2008
Core Elements of an MTM Service a transition of care, when actual or potential medication-
related problems are identified, or if the patient is suspected
Model in Pharmacy Practice to be at higher risk for medication-related problems.
The MTM service model in pharmacy practice includes the Ê>ÊV«ÀiiÃÛiÊ/,]Êì>ÞÊÌiÊ«>ÌiÌÊ«ÀiÃiÌÃÊ>Ê
following five core elements: current medications to the pharmacist, including all
UÊ i`V>ÌÊÌiÀ>«ÞÊÀiÛiÜÊ/,® prescription and nonprescription medications, herbal
UÊ *iÀÃ>Êi`V>ÌÊÀiVÀ`Ê*,® products, and other dietary supplements. The pharmacist
then assesses the patient’s medications for the presence of
UÊ i`V>ÌÀi>Ìi`Ê>VÌÊ«>Ê*® any medication-related problems, including adherence, and
UÊ ÌiÀÛiÌÊ>`ÉÀÊÀiviÀÀ>Ê works with the patient, the physician, or other healthcare
UÊ VÕiÌ>ÌÊ>`ÊvÜÕ« professionals to determine appropriate options for resolving
identified problems. In addition, the pharmacist supplies
the patient with education and information to improve the
These five core elements form a framework for the delivery patient’s self-management of his or her medications.
of MTM services in pharmacy practice. Every core element
is integral to the provision of MTM; however, the sequence />À}iÌi`Ê/,ÃÊ>ÀiÊÕÃi`ÊÌÊ>``ÀiÃÃÊ>Ê>VÌÕ>ÊÀÊ«ÌiÌ>Ê
and delivery of the core elements may be modified to meet i`V>ÌÀi>Ìi`Ê«ÀLi°Êì>Þ]ÊÌ>À}iÌi`Ê/,ÃÊ>ÀiÊ
an individual patient’s needs. performed for patients who have received a comprehensive
/,°Ê7iÌiÀÊvÀÊ>ÊiÜÊ«ÀLiÊÀÊÃÕLÃiµÕiÌÊÌÀ}]Ê
Medication Therapy Review: The the pharmacist assesses the specific therapy problem in the
medication therapy review (MTR) is a context of the patient’s complete medical and medication
history. Following assessment, the pharmacist intervenes
systematic process of collecting patient-specific and provides education and information to the patient, the
information, assessing medication therapies to physician or other healthcare professionals, or both, as
identify medication-related problems, devel- >««À«À>Ìi°Ê/iÊ/,ÊÃÊÌ>Ài`ÊÌÊÌiÊ`Û`Õ>Êii`ÃÊvÊ
the patient at each encounter.
oping a prioritized list of medication-related
i«i`}ÊÊÌÃÊÃV«i]ÊÌiÊ/,Ê>ÞÊ
problems, and creating a plan to resolve them. include the following:
UÊ ÊÌiÀÛiÜ}ÊÌiÊ«>ÌiÌÊÌÊ}>ÌiÀÊ`>Ì>ÊVÕ`}Ê
Ê/,ÊÃÊV`ÕVÌi`ÊLiÌÜiiÊÌiÊ«>ÌiÌÊ>`ÊÌiÊ«>À>VÃÌ°Ê demographic information, general health and activity
*>À>VÃÌ«ÀÛì`Ê/,Ê>`ÊVÃÕÌ>ÌÊÊÛ>ÀÕÃÊ status, medical history, medication history, immunization
settings has resulted in reductions in physician visits, history, and patients’ thoughts or feelings about their
emergency department visits, hospital days, and overall conditions and medication use28
healthcare costs.9,10,12,14,20,23–25 In addition, pharmacists have
been shown to obtain accurate and efficient medication- UÊ ÊÃÃiÃÃ}]ÊÊÌiÊL>ÃÃÊvÊ>ÊÀiiÛ>ÌÊVV>Ê
related information from patients. 10,26,27
Ê/iÊ/,ÊÃÊìÃ}i`Ê information available to the pharmacist, the patient’s
to improve patients’ knowledge of their medications, physical and overall health status, including current
address problems or concerns that patients may have, and previous diseases or conditions
and empower patients to self-manage their medications UÊ ÊÃÃiÃÃ}ÊÌiÊ«>ÌiÌ½ÃÊÛ>ÕiÃ]Ê«ÀiviÀiViÃ]ÊµÕ>ÌÞÊvÊ
and their health condition(s). life, and goals of therapy
/iÊ/,ÊV>ÊLiÊV«ÀiiÃÛiÊÀÊÌ>À}iÌi`ÊÌÊ>Ê>VÌÕ>ÊÀÊ UÊ ÊÃÃiÃÃ}ÊVÕÌÕÀ>ÊÃÃÕiÃ]Êi`ÕV>ÌÊiÛi]Ê>}Õ>}iÊ
«ÌiÌ>Êi`V>ÌÀi>Ìi`Ê«ÀLi°Ê,i}>ÀìÃÃÊvÊÜiÌ- barriers, literacy level, and other characteristics of
iÀÊÌiÊ/,ÊÃÊV«ÀiiÃÛiÊÀÊÌ>À}iÌi`]Ê«>ÌiÌÃÊ>ÞÊLiÊ the patient’s communication abilities that could affect
identified as requiring this service in a variety of ways. outcomes
Commonly, patients may be referred to a pharmacist by UÊ Ê Û>Õ>Ì}ÊÌiÊ«>ÌiÌÊÌÊìÌiVÌÊÃÞ«ÌÃÊÌ>ÌÊVÕ`Ê
their health plan, another pharmacist, physician, or other be attributed to adverse events caused by any of his or
i>ÌV>ÀiÊ«ÀviÃÃ>Ã°Ê*>ÌiÌÃÊ>ÞÊ>ÃÊÀiµÕiÃÌÊ>Ê/,Ê her current medications
independent of any referral. Additional opportunities for UÊ ÊÌiÀ«ÀiÌ}]ÊÌÀ}]Ê>`Ê>ÃÃiÃÃ}Ê«>ÌiÌ½Ã
«ÀÛ`}Ê>Ê/,ÊVÕìÊÜiÊ>Ê«>ÌiÌÊÃÊiÝ«iÀiV}Ê laboratory results
5
UÊ Ê ÃÃiÃÃ}]ÊìÌvÞ}]Ê>`Ê«ÀÀÌâ}Êi`V>Ì UÊ
Ê >V}Ê«>ÌiÌÃÊÌÊLiÊi«ÜiÀi`ÊÌÊ>>}iÊ
related problems related to their medications
» The clinical appropriateness of each medication UÊ ÊÌÀ}Ê>`ÊiÛ>Õ>Ì}ÊÌiÊ«>ÌiÌ½ÃÊÀiÃ«ÃiÊÌÊ
being taken by the patient, including benefit therapy, including safety and effectiveness
versus risk UÊ Ê
ÕV>Ì}Ê>««À«À>ÌiÊvÀ>ÌÊÌÊÌiÊ
» The appropriateness of the dose and dosing physician or other healthcare professionals, including
regimen of each medication, including consid- consultation on the selection of medications, sug-
eration of indications, contraindications, gestions to address identified medication problems,
potential adverse effects, and potential updates on the patient’s progress, and recommended
problems with concomitant medications follow-up care29
» Therapeutic duplication or other unnecessary In this service model, a patient would receive an annual
medications V«ÀiiÃÛiÊ/,Ê>`Ê>``Ì>ÊÌ>À}iÌi`Ê/,ÃÊÌÊ
» Adherence to the therapy address new or ongoing medication-related problem(s).
Significant events such as important changes in the patient’s
» Untreated diseases or conditions
medication therapy, changes in the patient’s needs or re-
» Medication cost considerations sources, changes in the patient’s health status or condition,
» i>ÌV>ÀiÉi`V>ÌÊ>VViÃÃÊVÃìÀ>ÌÃ a hospital admission or discharge, an emergency depart-
UÊ ÊiÛi«}Ê>Ê«>ÊvÀÊÀiÃÛ}Êi>VÊi`V>Ì ment visit, or an admission or discharge from a long-term
related problem identified care or assisted-living facility could necessitate additional
V«ÀiiÃÛiÊ/,Ã°
UÊ Ê*ÀÛ`}Êi`ÕV>ÌÊ>`ÊÌÀ>}ÊÊÌiÊ>««À«À>ÌiÊ
use of medications and monitoring devices and the
importance of medication adherence and
understanding treatment goals
6
March 2008
Personal Medication Record: The personal UÊ Ê >ÌiÊ>ÃÌÊÀiÛiÜi`ÊLÞÊÌiÊ«>À>VÃÌ]Ê«ÞÃV>]ÊÀÊ
other healthcare professional
medication record (PMR) is a comprehensive
UÊ *>ÌiÌ½ÃÊÃ}>ÌÕÀiÊ
record of the patient’s medications (prescription UÊ i>ÌV>ÀiÊ«ÀÛìÀ½ÃÊÃ}>ÌÕÀi
and nonprescription medications, herbal UÊ ÀÊi>VÊi`V>Ì]ÊVÕÃÊvÊÌiÊvÜ}\Ê
products, and other dietary supplements). » Medication (e.g., drug name and dose)
Within the MTM core elements service model, the patient » Indication (e.g., Take for…)
receives a comprehensive record of his or her medica- » ÃÌÀÕVÌÃÊvÀÊÕÃiÊi°}°]Ê7iÊ`ÊÊÌ>iÊÌ¶®Ê
tions (prescription and nonprescription medications, herbal » Start date
products, and other dietary supplements) that has been
completed either by the patient with the assistance of the » Stop date
pharmacist or by the pharmacist, or the patient’s existing » Ê"ÀìÀ}Ê«ÀiÃVÀLiÀÉVÌ>VÌÊvÀ>ÌÊ
*,ÊÃÊÕ«`>Ìi`°Êì>Þ]ÊÌiÊ«>ÌiÌ½ÃÊ*,ÊÜÕ`ÊLiÊ}iiÀ- (e.g., doctor)
ated electronically, but it also may be produced manually. » Special instructions
7iÌiÀÊÌiÊ«>À>VÃÌÊ«ÀÛìÃÊÌiÊ*,Ê>Õ>ÞÊÀÊ /iÊ*,ÊÃÊÌiì`ÊvÀÊ«>ÌiÌÃÊÌÊÕÃiÊÊi`V>ÌÊ
electronically, the information should be written at a literacy Ãiv>>}iiÌ°Ê/iÊ>Ìi>ViÊvÊÌiÊ*,ÊÃÊ>ÊV-
level that is appropriate for and easily understood by the laborative effort among the patient, pharmacist, physician,
«>ÌiÌ°ÊÊÃÌÌÕÌ>ÊÃiÌÌ}Ã]ÊÌiÊ*,Ê>ÞÊLiÊVÀi>Ìi`Ê and other healthcare professionals. Patients should be
at discharge from the medication administration record or encouraged to maintain and update this perpetual docu-
patient chart for use by the patient in the outpatient setting. iÌ°Ê*>ÌiÌÃÊÃÕ`ÊLiÊi`ÕV>Ìi`ÊÌÊV>ÀÀÞÊÌiÊ*,ÊÜÌÊ
/iÊ*,ÊVÌ>ÃÊvÀ>ÌÊÌÊ>ÃÃÃÌÊÌiÊ«>ÌiÌÊÊÃÊÀÊ them at all times and share it at all healthcare visits and at
her overall medication therapy self-management. A sample all admissions to or discharges from institutional settings to
*,ÊÃÊVÕì`ÊÊ««i`ÝÊ
°Ê help ensure that all healthcare professionals are aware of
/iÊ*,]ÊÜVÊÃÊÌiì`ÊvÀÊÕÃiÊLÞÊÌiÊ«>ÌiÌ]Ê>ÞÊ their current medication regimen.
include the following information:30 Each time the patient receives a new medication; has a
UÊ *>ÌiÌÊ>iÊ current medication discontinued; has an instruction change;
UÊ *>ÌiÌÊLÀÌÊ`>ÌiÊ begins using a new prescription or nonprescription medi-
cation, herbal product, or other dietary supplement; or has
UÊ *>ÌiÌÊ«iÊÕLiÀ any other changes to the medication regimen, the patient
UÊ Ê iÀ}iVÞÊVÌ>VÌÊvÀ>ÌÊÊ ÃÕ`ÊÕ«`>ÌiÊÌiÊ*,ÊÌÊi«ÊiÃÕÀiÊ>ÊVÕÀÀiÌÊ>`Ê
(Name, relationship, phone number) accurate record. Ideally, the pharmacist, physician, and
UÊ Ê*À>ÀÞÊV>ÀiÊ«ÞÃV>Ê other healthcare professionals can actively assist the patient
(Name and phone number) ÜÌÊÌiÊ*,ÊÀiÛÃÊ«ÀViÃÃ°
UÊ Ê*>À>VÞÉ«>À>VÃÌÊÊ *>À>VÃÌÃÊ>ÞÊÕÃiÊÌiÊ*,ÊÌÊVÕV>ÌiÊ>`ÊV>L-
(Name and phone number) rate with physicians and other healthcare professionals to
UÊ ÊiÀ}iÃÊi°}°]Ê7>ÌÊ>iÀ}iÃÊ`ÊÊ>Ûi¶Ê7>ÌÊ achieve optimal patient outcomes. Widespread use of the
>««ii`ÊÜiÊÊ>`ÊÌiÊ>iÀ}ÞÊÀÊÀi>VÌ¶® *,ÊÜÊÃÕ««ÀÌÊÕvÀÌÞÊvÊvÀ>ÌÊ«ÀÛì`ÊÌÊ>Ê
UÊ Ê"ÌiÀÊi`V>ÌÀi>Ìi`Ê«ÀLiÃÊi°}°]Ê7>ÌÊ healthcare professionals and enhance the continuity of care
i`V>ÌÊV>ÕÃi`ÊÌiÊ«ÀLi¶Ê7>ÌÊÜ>ÃÊÌiÊ provided to patients while facilitating flexibility to account
«ÀLiÊÊ>`¶® for pharmacy- or institution-specific variations.
UÊ Ê*ÌiÌ>ÊµÕiÃÌÃÊvÀÊ«>ÌiÌÃÊÌÊ>ÃÊ>LÕÌÊÌiÀÊ
medications (e.g., When you are prescribed a new
drug, ask your doctor or pharmacist...)
UÊ >ÌiÊ>ÃÌÊÕ«`>Ìi`Ê
7
Medication-Related Action Plan: active participation in his or her medication-adherence
behavior and overall MTM. A sample MAP is included in
The medication-related action plan (MAP) is Appendix D.
a patient-centric document containing a list of The MAP, which is intended for use by the patient, may
actions for the patient to use in tracking progress include the following information:
for self-management. UÊ *>ÌiÌÊ>i
A care plan is the health professional’s course of action UÊ Ê*À>ÀÞÊV>ÀiÊ«ÞÃV>Ê
for helping a patient achieve specific health goals.31 The (Doctor’s name and phone number)
care plan is an important component of the documentation UÊ Ê*>À>VÞÉ«>À>VÃÌÊ
core element outlined in this service model. In addition to *>À>VÞÊ>iÉ«>À>VÃÌÊ>iÊ>`Ê
the care plan, which is developed by the pharmacist and phone number)
used in the collaborative care of the patient, the patient UÊ >ÌiÊvÊ*ÊVÀi>ÌÊ>ÌiÊ«Ài«>Ài`®
receives an individualized MAP for use in medication self-
management. Completion of the MAP is a collaborative UÊ ÊVÌÊÃÌi«ÃÊvÀÊÌiÊ«>ÌiÌ\Êº7>ÌÊÊii`ÊÌÊ`°°°»
effort between the patient and the pharmacist. The patient UÊ ÌiÃÊvÀÊÌiÊ«>ÌiÌ\Ê»7>ÌÊÊ``Ê>`ÊÜiÊÊ``ÊÌ°°°»
MAP includes only items that the patient can act on that are UÊ Ê««ÌiÌÊvÀ>ÌÊvÀÊvÜÕ«ÊÜÌÊ
within the pharmacist’s scope of practice or that have been pharmacist, if applicable
agreed to by relevant members of the healthcare team. The Specific items that require intervention and that have been
MAP should not include outstanding action items that still approved by other members of the healthcare team and
require physician or other healthcare professional review any new items within the pharmacist’s scope of practice
or approval. The patient can use the MAP as a simple should be included on a MAP distributed to the patient on
guide to track his or her progress. The Institute of Medicine a follow-up visit. In institutional settings the MAP could be
has advocated the need for a patient-centered model of established at the time the patient is discharged for use by
healthcare.7 The patient MAP, coupled with education, is an the patient in medication self-management.
essential element for incorporating the patient-centered ap-
proach into the MTM service model. The MAP reinforces a
sense of patient empowerment and encourages the patient’s
8
March 2008
Intervention and/or Referral: The pharma- Some patients’ medical conditions or medication therapy
may be highly specialized or complex and the patient’s
cist provides consultative services and intervenes needs may extend beyond the core elements of MTM
to address medication-related problems; when service delivery. In such cases, pharmacists may provide
necessary, the pharmacist refers the patient to a additional services according to their expertise or refer the
patient to a physician, another pharmacist, or other
physician or other healthcare professional. healthcare professional.
During the course of an MTM encounter, medication-related Examples of circumstances that may require referral include
problems may be identified that require the pharmacist to the following:
intervene on the patient’s behalf. Interventions may include
collaborating with physicians or other healthcare profes- UÊ Ê Ê«>ÌiÌÊ>ÞÊiÝLÌÊ«ÌiÌ>Ê«ÀLiÃÊ`ÃVÛiÀi`Ê
sionals to resolve existing or potential medication-related `ÕÀ}ÊÌiÊ/,ÊÌ>ÌÊ>ÞÊiViÃÃÌ>ÌiÊÀiviÀÀ>ÊvÀÊiÛ>Õ-
problems or working with the patient directly. The com- ation and diagnosis
munication of appropriate information to the physician or UÊ ÊÊ«>ÌiÌÊ>ÞÊÀiµÕÀiÊ`Ãi>ÃiÊ>>}iiÌÊi`ÕV>ÌÊ
other healthcare professional, including consultation on the to help him or her manage chronic diseases such as
selection of medications, suggestions to address medication diabetes
problems, and recommended follow-up care, is integral to UÊ ÊÊ«>ÌiÌÊ>ÞÊÀiµÕÀiÊÌÀ}ÊvÀÊ}ÀÃÊ
the intervention component of the MTM service model.29 medications (e.g., warfarin, phenytoin,
The positive impact of pharmacist interventions on outcomes methotrexate)
related to medication-related problems has been demon- /iÊÌiÌÊvÊÌiÀÛiÌÊ>`ÉÀÊÀiviÀÀ>ÊÃÊÌÊ«ÌâiÊ
strated in numerous studies.32–37 Appropriate resolution of medication use, enhance continuity of care, and encourage
medication-related problems involves collaboration and patients to avail themselves of healthcare services to prevent
communication between the patient, the pharmacist, and future adverse outcomes.
the patient’s physician or other healthcare
professionals.
9
Documentation and Follow-up: MTM UÊ *ÀÌiVÌ}Ê>}>ÃÌÊ«ÀviÃÃ>Ê>LÌÞÊ
services are documented in a consistent manner, UÊ Ê
>«ÌÕÀ}ÊÃiÀÛViÃÊ«ÀÛì`ÊvÀÊÕÃÌwV>ÌÊvÊ
billing or reimbursement (e.g., payer audits)
and a follow-up MTM visit is scheduled based UÊ ÊiÃÌÀ>Ì}ÊÌiÊÛ>ÕiÊvÊ«>À>VÃÌ«ÀÛì`Ê
on the patient’s medication-related needs, or the MTM services
patient is transitioned from one care setting to UÊ ÊiÃÌÀ>Ì}ÊVV>]ÊiVV]Ê>`Ê
humanistic outcomes
another.
MTM documentation includes creating and maintaining an
Documentation is an essential element of the MTM ongoing patient-specific record that contains, in chronologi-
service model. The pharmacist documents services and cal order, a record of all provided care in an established
intervention(s) performed in a manner appropriate for ÃÌ>`>À`Êi>ÌV>ÀiÊ«ÀviÃÃ>ÊvÀ>ÌÊi°}°]ÊÌiÊ-"*Ê
evaluating patient progress and sufficient for billing [subjective observations, objective observations, assessment,
purposes. and plan] note38).
Proper documentation of MTM services may serve several Ideally, documentation will be completed electronically or
purposes including, but not limited, to the following: alternatively on paper. The inclusion of resources such as a
UÊ Ê >VÌ>Ì}ÊVÕV>ÌÊLiÌÜiiÊÌiÊ«>À>VÃÌÊ *,]Ê>Ê*]Ê>`ÊÌiÀÊ«À>VÌViÃ«iVwVÊvÀÃÊÜÊ>ÃÃÃÌÊÌiÊ
and the patient’s other healthcare professionals regard- pharmacist in maintaining consistent professional documen-
ing recommendations intended to resolve or monitor tation. The use of consistent documentation will help facili-
actual or potential medication-related problems tate collaboration among members of the healthcare team
while accommodating practitioner, facility, organizational,
UÊ «ÀÛ}Ê«>ÌiÌÊV>ÀiÊ>`ÊÕÌViÃ
or regional variations.
UÊ Ê >V}ÊÌiÊVÌÕÌÞÊvÊ«>ÌiÌÊV>ÀiÊ>}Ê
providers and care settings
UÊ Ê ÃÕÀ}ÊV«>ViÊÜÌÊ>ÜÃÊ>`ÊÀi}Õ>ÌÃÊ
for the maintenance of patient records
Documentation elements for the patient record may include, but are not limited to, the following:22,29,38–40
Documentation category Examples
Patient demographics Basic information: address, phone, e-mail, gender, age, ethnicity, education status,
patient’s special needs, health plan benefit/insurance coverage
Subjective observations Pertinent patient-reported information: previous medical history, family history,
social history, chief complaints, allergies, previous adverse drug reactions
Objective observations Known allergies, diseases, conditions, laboratory results, vital signs, diagnostic
signs, physical exam results, review of systems
Assessment Problem list, assessment of medication-related problems
Plan A care plan is the healthcare professional’s course of action for helping a patient
achieve specific health goals
Education Goal setting and instruction provided to the patient with verification of understanding
Collaboration Communication with other healthcare professionals: recommendations, referrals, and
correspondence with other professionals (cover letter, SOAP note)
PMR A record of all medications, including prescription and nonprescription medications,

herbal products, and other dietary supplements
MAP Patient-centric document containing a list of actions to use in tracking progress
for self-management
Follow-up Transition plan or scheduling of next follow-up visit
Billing Amount of time spent on patient care, level of complexity, amount charged
10
March 2008
External Communication of Conclusion
MTM Documentation
The MTM core elements, as presented in this document,
Following documentation of the MTM encounter, appropri- are intended to be applicable to patients in all care set-
ate external communication should be provided or sent to tings where the patients or their caregivers can be actively
key audiences, including patients, physicians, and payers. involved with managing their medication therapy, taking full
Providing the patient with applicable documentation that >`Û>Ì>}iÊvÊÌiÊ«>À>VÃÌ½ÃÊÀiÊ>ÃÊÌiÊºi`V>ÌÊÌiÀ-
he or she can easily understand is vital to facilitating active >«ÞÊiÝ«iÀÌ°»ÊyÜÊV>ÀÌÊvÊÌiÊVÀiÊiiiÌÃÊvÊ>Ê/Ê
involvement in the care process. Documentation provided service model contained in this document can be found in
ÌÊÌiÊ«>ÌiÌÊ>ÌÊÌiÊ/ÊiVÕÌiÀÊ>ÞÊVÕìÊÌiÊ*,]Ê Appendix E. As the core elements service model continues
MAP, and additional education materials. Documentation to to evolve to meet diverse patient needs, pharmacists are
physicians and other healthcare professionals may include encouraged to make the most of the framework provided to
>ÊVÛiÀÊiÌÌiÀ]ÊÌiÊ«>ÌiÌ½ÃÊ*,]ÊÌiÊ-"*ÊÌi]Ê>`ÊV>ÀiÊ improve patient outcomes and medication use.
plan. Communicating with payers and providing appropri-
ate billing information may also be necessary and could
include the name of the pharmacist or pharmacy and
appropriate identifier, services provided, time spent on
patient care, and appropriate billing codes.
Follow-up
When a patient’s care setting changes (e.g., hospital admis-
sion, hospital to home, hospital to long-term care facility,
home to long-term care facility), the pharmacist transi-
tions the patient to another pharmacist in the patient’s new
care setting to facilitate continued MTM services. In these
situations, the initial pharmacist providing MTM services
participates cooperatively with the patient’s new pharmacist
provider to facilitate the coordinated transition of the
patient, including the transfer of relevant medication and
other health-related information.
If the patient will be remaining in the same care setting,
the pharmacist should arrange for consistent follow-up
MTM services in accordance with the patient’s unique
medication-related needs. All follow-up evaluations and
interactions with the patient and his or her other healthcare
professional(s) should be included in MTM documentation.
11
References
1. American Pharmacists Association, National Association of Chain Drug 20. Galt KA. Cost avoidance, acceptance, and outcomes associated with
Stores Foundation. Medication therapy management in community phar- a pharmacotherapy consult clinic in a Veterans Affairs medical center. Phar-
macy practice: core elements of an MTM service (version 1.0). macotherapy. 1998;18:1103-11.
J Am Pharm Assoc. 2005;45:573-9.
21. Rovers J, Currie J, Hagel H, et al. Re-engineering the pharmacy layout.
2. Wagner EH. Chronic disease management: What will it take to improve care In: A Practical Guide to Pharmaceutical Care. 2nd ed. Washington, DC:
for chronic illness? Effective Clinical Practice. 1998;1(1):2-4. American Pharmacists Association; 2003:261-6.
3. Institute of Medicine. Crossing the Quality Chasm: A New Health System 22. Rovers J, Currie J, Hagel H, et al. Patient data collection. In: A Practical
for the 21st Century. Washington, DC: Institute of Medicine; 2001. Guide to Pharmaceutical Care. 2nd ed. Washington, DC: American Phar-
macists Association; 2003:26-51.
4. Cipolle RJ. Strand LM, Morley PC. Pharmaceutical Care Practice:
The Clinician’s Guide. New York: McGraw Hill; 2004. 23. Borgsdorf LR, Miano JS, Knapp KK. Pharmacist-managed medication
review in a managed care system. Am J Hosp Pharm. 1994;51:772-7.
5. McGivney MS, Meyer SM, Duncan-Hewitt W, et al. Medication therapy
management: its relationship to patient counseling, disease management, 24. Bond CA, Raehl CL, Franke T. Clinical pharmacy services, pharmacy staffing,
and pharmaceutical care. J Am Pharm Assoc. 2007;45:620-8. and the total cost of care in the United States hospitals.
Pharmacotherapy. 2000;20:609-21.
6. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the
cost-of-illness model. J Am Pharm Assoc. 2001;41:192-9. 25. Christensen D, Trygstad T, Sullivan R, et al. A pharmacy management
intervention for optimizing drug therapy for nursing home patients. Am J
7. Institute of Medicine. Report Brief: Preventing Medication Errors. Geriatr Pharmacother. 2004;2:248-56.
Washington, DC: Institute of Medicine; July 2006. http://www.iom.edu/
Object.File/Master/35/943/medication%20errors%20new.pdf. Accessed 26. Gurwich EL. Comparison of medication histories acquired by
September 1, 2007. pharmacists and physicians. Am J Hosp Pharm. 1983;40:1541-2.
8. Centers for Medicare & Medicaid Services. Medicare Prescription Drug 27. Nester TM, Hale LS. Effectiveness of a pharmacist-acquired medication his-
Benefit Final Rule: 42 CFR Parts 400, 403, 411, 417, and 423 Medicare tory in promoting patient safety. Am J Health Syst Pharm. 2003;3-14.
Program. Federal Register, vol. 70, no. 18. January 28, 2005. http://
28. Rovers J, Currie J, Hagel H, et al. The case for pharmaceutical care. In: A
a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.
Practical Guide to Pharmaceutical Care. 2nd ed. Washington, DC: Ameri-
gov/2005/pdf/05-1321.pdf. Accessed September 1, 2007.
can Pharmacists Association, 2003:3-4.
9. Garrett D, Bluml B. Patient self-management program for diabetes: first-
29. Berger BA. Interacting with physicians. In: Communication Skills for
year clinical, humanistic, and economic outcomes. J Am Pharm Assoc.
Pharmacists. 2nd ed. Washington, DC: American Pharmacists
2005;45:130-7.
Association; 2005:131-9.
10. Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term
30. Executive summary of the American Society of Health System
clinical and economic outcomes of a community pharmacy diabetes care
Pharmacists (ASHP) and ASHP Research and Education
program. J Am Pharm Assoc. 2003;43:173-90.
Foundation Continuity of Care in Medication Use Summit.
11. Chrischilles EA, Carter BL, Lund BC, et al. Evaluation of the Iowa Am J Health Syst Pharm. In press.
Medicaid pharmaceutical case management program.
31. Rovers J, Currie J, Hagel H, et al. Patient care plan development. In: A Prac-
J Am Pharm Assoc. 2004;44:337-49.
tical Guide to Pharmaceutical Care. 2nd ed. Washington, DC: American
12. Bunting BA, Cranor CW. The Asheville Project: long-term clinical, humanis- Pharmacists Association, 2003:69.
tic, and economic outcomes of a community-based
32. Rupp MT. Value of the community pharmacists’ interventions to
medication therapy management program for asthma.
correct prescribing errors. Ann Pharmacother. 1992;26:1580-4.
J Am Pharm Assoc. 2003;46:133-47.
33. McMullin ST, Hennenfent JA, Ritchie D, et al. A prospective
13. Jameson J, VanNoord G, Vanderwould K. The impact of a pharmacotherapy
randomized trial to assess the cost impact of pharmacist-initiated interven-
consultation on the cost and outcome of medical therapy.
tions. Arch Intern Med. 1999;159:2306-9.
J Fam Pract. 1995;41(5):469-72.
34. Knapp KK, Katzman H, Hambright JS, et al. Community pharmacist inter-
14. Lipton HL, Bero LA, Bird JA, et al. The impact of clinical pharmacists’
vention in a capitated pharmacy benefit contract.
consultations on physicians’ geriatric drug prescribing.
Am J Health Syst Pharm. 1998;55:1141-5.
Med Care. 1992;30:646-58.
35. Dobie RL, Rascati KL. Documenting the value of pharmacist
15. Schumock GT, Butler MG, Meek PD, et al. Evidence of the economic benefit
interventions. Am Pharm. 1994;NS34(5):50-4.
of clinical pharmacy services: 1996–2000.
Pharmacotherapy. 2003;23:113-132. 36. Hepler CD, Strand LM. Opportunities and responsibilities in
pharmaceutical care. Am J Hosp Pharm. 1990;47:533-43.
16. Minnesota Department of Human Services. MHCP enrolled professionals:
medication therapy management services. http://www.dhs.state.mn.us/ 37. Bootman JL, Harrison DL, Cox E. The healthcare cost of
main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelection drug-related morbidity and mortality in nursing facilities.
Method=LatestReleased&dDocName=id_055325#P116_7762. Accessed Arch Intern Med. 1997;157:2089-96.
February 5, 2007.
38. Zierler-Brown S, Brown TR, Chen D, et al. Clinical documentation
17. Traynor K. Wyoming program brings pharmacist consultations home. Am J for patient care: models, concepts, and liability considerations for pharma-
Health Syst Pharm. 2004;61:760. cists. Am J Health Syst Pharm. 2007;64:1851-8.
18. North Carolina Department of Health and Human Services. North 39. Currie JD, Doucette WR, Kuhle J, et al. Identification of essential
Carolina Medicaid: Medication Therapy Management Program (MTMP). elements in documentation of pharmacist-provided care.
August 2006. http://www.dhhs.state.nc.us/dma/Forms/ J Am Pharm Assoc. 2003;43:41-9.
mtmpinstructions.pdf. Accessed September 1, 2007.
40. Culhane N, Brooks A, Cohen V, et al. Medication therapy management
19. Touchette DR, Burns AL, Bough MA, et al. Survey of medication therapy services: Application of the core elements in ambulatory settings. American
12 management programs under Medicare part D. J Am Pharm Assoc. College of Clinical Pharmacy. March 14, 2007.
2006;46:683-91.
March 2008
Appendix A. Definition of Medication Therapy Management (MTM)V
Medication Therapy Management is a distinct service or A program that provides coverage for Medication Therapy
group of services that optimize therapeutic outcomes for in- Management services shall include:
dividual patients. Medication Therapy Management services
a. Patient-specific and individualized services or sets
are independent of, but can occur in conjunction with, the
of services provided directly by a pharmacist to the
provision of a medication product.
patient.* These services are distinct from formulary de-
Medication Therapy Management encompasses a broad velopment and use, generalized patient education and
range of professional activities and responsibilities within information activities, and other population-focused
the licensed pharmacist’s, or other qualified healthcare quality-assurance measures for medication use
provider’s, scope of practice. These services include but b. Face-to-face interaction between the patient* and the
are not limited to the following, according to the individual pharmacist as the preferred method of delivery. When
needs of the patient: patient-specific barriers to face-to-face communication
a. Performing or obtaining necessary assessments of the exist, patients shall have equal access to appropri-
patient’s health status ate alternative delivery methods. Medication Therapy
Management programs shall include structures sup-
b. Formulating a medication treatment plan
porting the establishment and maintenance of the
c. Selecting, initiating, modifying, or administering patient*–pharmacist relationship
medication therapy
V°Ê Ê"««ÀÌÕÌiÃÊvÀÊ«>À>VÃÌÃÊ>`ÊÌiÀÊµÕ>wi`Ê
d. Monitoring and evaluating the patient’s response to healthcare providers to identify patients who should
therapy, including safety and effectiveness receive medication therapy management services
e. Performing a comprehensive medication review to d. Payment for medication therapy management ser-
identify, resolve, and prevent medication-related prob- vices consistent with contemporary provider payment
lems, including adverse drug events rates that are based on the time, clinical intensity, and
f. Documenting the care delivered and communicating resources required to provide services (e.g., Medicare
essential information to the patient’s other primary *>ÀÌÊÊ>`ÉÀÊ*>ÀÌÊ ÊvÀÊ
*/Ê>`Ê, ,6-®
care providers e. Processes to improve continuity of care, outcomes, and
g. Providing verbal education and training designed to outcome measures
enhance patient understanding and appropriate use of Approved July 27, 2004, by the Academy of Managed
ÃÉiÀÊi`V>ÌÃ Care Pharmacy, the American Association of Colleges
h. Providing information, support services, and resources of Pharmacy, the American College of Apothecaries, the
ìÃ}i`ÊÌÊi>ViÊ«>ÌiÌÊ>ìÀiViÊÜÌÊÃÉiÀÊ American College of Clinical Pharmacy, the American So-
therapeutic regimens ciety of Consultant Pharmacists, the American Pharmacists
i. Coordinating and integrating medication therapy Association, the American Society of Health-System Phar-
management services within the broader healthcare macists, the National Association of Boards of Pharmacy,**
management services being provided to the patient the National Association of Chain Drug Stores, the National
Community Pharmacists Association, and the National
Council of State Pharmacy Association Executives.
* In some situations, medication therapy management services may be provided to the caregiver or
other persons involved in the care of the patient.
** Organization policy does not allow NABP to take a position on payment issues.
VBluml BM. Definition of medication therapy management: development of profession wide consensus.
J Am Pharm Assoc. 2005;45:566–72.
13
Appendix B. Considerations for Identification of Patients Who
May Benefit From MTM Services
Any patients using prescription and nonprescription UÊ *Ê >ÌiÌÊ>ÃÊ>LÀ>ÌÀÞÊÛ>ÕiÃÊÕÌÃìÊÌiÊÀ>ÊÀ>}iÊ
medications, herbal products, and other dietary supple- that could be caused by or may be improved with
ments could potentially benefit from the medication therapy medication therapy
management (MTM) services described in the core elements UÊ Ê*>ÌiÌÊ>ÃÊìÃÌÀ>Ìi`Ê>ìÀiViÊVÕ`}Ê
outlined in this service model, especially if medication- underuse and overuse) to a medication regimen
related problems or issues are discovered or suspected.
UÊ Ê*>ÌiÌÊ>ÃÊÌi`Êi>ÌÊÌiÀ>VÞÊÀÊVÕÌÕÀ>Ê
Patients may be evaluated for MTM services regardless of
differences, requiring special communication
the number of medications they use, their specific disease
strategies to optimize care
state(s), or their health plan coverage.
UÊ Ê*>ÌiÌÊÜ>ÌÃÊÀÊii`ÃÊÌÊÀi`ÕViÊÕÌv«ViÌÊ
"««ÀÌÕÌiÃÊvÀÊÌiÊìÌwV>ÌÊvÊ«>ÌiÌÃÊÌ>À}iÌi`ÊvÀÊ medication costs
MTM services may result from many sources including, but
UÊ Ê*>ÌiÌÊ>ÃÊiÝ«iÀiVi`Ê>ÊÃÃÊÀÊÃ}wV>ÌÊV>}iÊÊ
not limited to, pharmacist identification, physician referral,
health plan benefit or insurance coverage
patient self-referral, and health plan or other payer referral.
Pharmacists may wish to notify physicians or other health- UÊ Ê*>ÌiÌÊ>ÃÊÀiViÌÞÊiÝ«iÀiVi`Ê>Ê>`ÛiÀÃiÊiÛiÌÊ
care professionals in their community or physicians within (medication or non-medication-related) while
their facility, if applicable, of their MTM services, so that receiving care
physicians may refer patients for MTM services. UÊ Ê*>ÌiÌÊÃÊÌ>}Ê}ÀÃÊi`V>ÌÃ®]ÊVÕ`}Ê
narrow therapeutic index drugs (e.g., warfarin,
To provide assistance in prioritizing who may benefit most
phenytoin, methotrexate)
from MTM services, pharmacists, health plans, physicians,
other healthcare professionals, and health systems may UÊ Ê*>ÌiÌÊÃivìÌwiÃÊ>`Ê«ÀiÃiÌÃÊÜÌÊ«iÀViÛi`Êii`Ê
consider using one or more of the following factors to target for MTM services
patients who are likely to benefit most from MTM services:
UÊ *Ê >ÌiÌÊ>ÃÊiÝ«iÀiVi`Ê>ÊÌÀ>ÃÌÊvÊV>Ài]Ê>`ÊÃÊÀÊ
her regimen has changed
UÊ Ê*>ÌiÌÊÃÊÀiViÛ}ÊV>ÀiÊvÀÊÀiÊÌ>ÊiÊ«ÀiÃVÀLiÀ
UÊ Ê*>ÌiÌÊÃÊÌ>}ÊwÛiÊÀÊÀiÊVÀVÊi`V>ÌÃÊ
(including prescription and nonprescription medica-
tions, herbal products, and other dietary supplements)
UÊ Ê*>ÌiÌÊ>ÃÊ>ÌÊi>ÃÌÊiÊVÀVÊ`Ãi>ÃiÊÀÊVÀVÊ
health condition (e.g., heart failure, diabetes,
hypertension, hyperlipidemia, asthma, osteoporosis,
depression, osteoarthritis, chronic obstructive
pulmonary disease)
14
March 2008
Appendix C. Sample Personal Medication Record
Patients, professionals, payers, and health information technology system vendors are encouraged to develop a format that
iiÌÃÊ`Û`Õ>Êii`Ã]ÊViVÌ}ÊiiiÌÃÊÃÕVÊ>ÃÊÌÃiÊÊÌiÊÃ>«iÊ«iÀÃ>Êi`V>ÌÊÀiVÀ`Ê*,®°
(Note: Sample PMR is two pages or one page front and back)
MY MEDICATION RECORD
side 1
Name:________________________________________________________________ Birth date: _______________________________ LOGO
VÕìÊ>ÊvÊÞÕÀÊi`V>ÌÃÊÊÌÃÊÀiVÀ`\Ê«ÀiÃVÀ«ÌÊi`V>ÌÃ]Ê«ÀiÃVÀ«ÌÊi`V>ÌÃ]ÊiÀL>Ê«À`ÕVÌÃ]Ê>`ÊÌiÀÊìÌ>ÀÞÊÃÕ««iiÌÃ»°
Include all of your medications on this reord: prescription medications, nonprescription medications, herbal products, and other dietary supplements.
Always carry your medication record with you and show it to all your doctors, pharmacists and other healthcare providers.
Drug When do I take it?

Take for... Start Date Stop Date Doctor Special Instructions
Name Dose Morning Noon Evening Bedtime
'LYBURIDE MG $IABETES *OHNSON 4AKEWITHFOOD
08-029
This sample Personal Medical Record (PMR) is provided only for general informational purposes and does not constitute professional health care advice or treatment. The patient
(or other user) should not, under any circumstances, solely rely on, or act on the basis of, the PMR or the information therein. If he or she does so, then he or she does so at his or her
own risk. While intended to serve as a communication aid between patient (or other user) and health care provider, the PMR is not a substitute for obtaining professional healthcare
advice or treatment. This PMR may not be appropriate for all patients (or other users). The National Association of Chain Drug Stores Foundation and the American Pharmacists
Association assume no responsibility for the accuracy, currentness, or completeness of any information provided or recorded herein.
APhA and the NACDS Foundation encourage the use of this document in a manner and form that serves the individual needs of practitioners.
All reproductions, including modified forms, should include the following statement: “This form is based on forms developed by the
American Pharmacists Association and the National Association of Chain Drug Stores Foundation. Reproduced with permission from APhA
and NACDS Foundation.”
15
MY MEDICATION RECORD
side 2
Name: ____________________________________ Birth date: _______________ Phone:_______________________
!LWAYSCARRYYOURMEDICATIONRECORDWITHYOUANDSHOWITTOALLYOURDOCTORSPHARMACISTSANDOTHERHEALTHCAREPROVIDERS
Emergency Contact Information

Name
Relationship
Phone Number
Primary Care Physician
Name
Phone Number
Pharmacy/Pharmacist
Name
Phone Number
Allergies
What allergies do I have? (Medicines, food, other) What happened when I had the allergy or reaction?
Other Medicine Problems

Name of medicine that caused problem What was the problem I had with the medicine?
When you are prescribed a new drug, ask your doctor or pharmacist:
s7HATAM)TAKING
s7HATISITFOR
s7HENDO)TAKEIT
s!RETHEREANYSIDEEFFECTS
s!RETHEREANYSPECIALINSTRUCTIONS
s7HATIF)MISSADOSE
Notes:
Date last updated
Date last reviewed by

Patient’s Signature Healthcare Provider’s Signature
08-029
healthcare provider
16
March 2008
Appendix D. Sample Medication-Related Action Plan (for the Patient)
Patients, healthcare professionals, payers, and health information technology system vendors are encouraged to
develop a format that meets individual and customer needs, collecting elements such as those included on the sample
medication-related action plan (MAP) below.
MY MEDICATION-RELATED ACTION PLAN
Patient:
Doctor (Phone):
Pharmacy/Pharmacist (Phone):
Date Prepared:
The list below has important Action Steps to help you get the most from your medications.
Follow the checklist to help you work with your pharmacist and doctor to manage your medications
AND make notes of your actions next to each item on your list.
Action Steps ∆What I need to do… Notes ∆ What I did and when I did it…
My Next Appointment with My Pharmacist is on:__________________(date) at __________ £ AM £ PM

08-029
17
Appendix E. Flow Chart of a Medication Therapy Management Service Model
18
March 2008
Addendum
Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0 was
developed with the input of an advisory panel of pharmacy leaders representing diverse pharmacy practice settings.
The pharmacy practice setting areas represented by members of the advisory panel included ambulatory care, community,
government technical support services, hospital, long-term care, managed care health systems, managed care organization
plan administration, and outpatient clinics.
MTM Core Elements Service Model Version 2.0 Advisory Panel Members
Marialice S. Bennett, RPh, FAPhA Macary Weck Marciniak, PharmD, BCPS
/iÊ"Ê-Ì>ÌiÊ1ÛiÀÃÌÞ Albany College of Pharmacy
Rebecca W. Chater, RPh, MPH, FAPhA Randy P. McDonough, PharmD, MS, CGP, BCPS
Kerr Drug, Inc. Towncrest and Medical Plaza Pharmacies
Kimberly Sasser Croley, PharmD, CGP, FASCP Melissa Somma McGivney, PharmD, CDE
Knox County Hospital University of Pittsburgh School of Pharmacy
Rachael Deck, PharmD Rick Mohall, PharmD
Walgreen Co. ,ÌiÊ`Ê
À«À>Ì
Jeffrey C. Delafuente, MS, FCCP, FASCP Anthony Provenzano, PharmD, CDE
Virginia Commonwealth University School of Pharmacy -1* ,61Ê*>À>ViÃ]ÊV°Ê
Susan L. Downard, RPh Michael Sherry, RPh
Kaiser Permanente of the Mid-Atlantic States, Inc CVS Caremark
Margherita Giuliano, RPh Steven T. Simenson, RPh, FAPhA
Connecticut Pharmacists Association Goodrich Pharmacies
Zandra Glenn, PharmD Donna S. Wall, RPh, PharmD, BCPS, FASHP
,-Ê*>À>VÞÊ-iÀÛViÃÊ-Õ««ÀÌÊ
iÌiÀÊ Clarian Healthcare Partners, Indiana University Hospital
Melinda C. Joyce, PharmD, FAPhA, FACHE Winston Wong, PharmD
The Medical Center CareFirst BCBS
Sandra Leal, PharmD, CDE
Ê,Ê
ÕÌÞÊi>ÌÊ
iÌiÀÊ
Staff
Ben Bluml, RPh Crystal Lennartz, PharmD, MBA
American Pharmacists Association Foundation National Association of Chain Drug Stores
Anne Burns, RPh James Owen, PharmD
American Pharmacists Association American Pharmacists Association
Ronna Hauser, PharmD Afton Yurkon, PharmD
National Association of Chain Drug Stores National Association of Chain Drug Stores
Medication Therapy Management in Pharmacy Practice: Core Elements of an MTM Service Model Version 2.0 advisory panel members
provided expert advice. The content of this document does not necessarily represent all of their opinions or those of their affiliated organizations.
19
NOTES
To request a single print copy of the publication, click on the following link:
http://fs6.formsite.com/APhA-NACDS/print_request/index.html
To provide comments and/or feedback on this publication, click on the following link:
http://fs6.formsite.com/APhA-NACDS/core_elements_feedback/index.html
To obtain a copy of a slide presentation explaining the MTM Core Elements Service
Model or to submit a request for a presentation to your organization or group, click on
the following link: http://fs6.formsite.com/APhA-NACDS/presentation_request/index.html
Medication Therapy Management in Pharmacy Practice

Core Elements of an MTM Service Model
Version 2.0
08-323

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Medication Therapy

This service model is supported by the following organizations:

PMR A record of all medications, including prescription and nonprescription medications,

Drug When do I take it?

'LYBURIDE MG $IABETES *OHNSON 4AKEWITHFOOD

Emergency Contact Information

Other Medicine Problems

Date last updated

Date last reviewed by

MY MEDICATION-RELATED ACTION PLAN

My Next Appointment with My Pharmacist is on:________(date) at £ AM £ PM