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Information updated (August
13)
The following are opportunities that
we would like to draw your attention to. Check back
regularly for additional opportunities as they arise:
MTM
Toolkit
Medication Therapy
Management Resources
(Special thanks to the Minnesota Pharmacists Association for the
following MTM Toolkit materials)
Please
use the information here to help you with questions regarding
MTM. Because we rely on feedback to determine what resources are
valuable to you, let us know if we don't have what you need.
Email your comments/suggestions to
Tim@vapharmacy.org.
Clinical Guidelines
It is recommended that all MTM pharmacists
should be
up-to-date on the following national disease state guidelines:
-
National Cholesterol Education
Program Guidelines (NCEP)
Detection, Evaluation, and Treatment
of High Blood Cholesterol in Adults (Adult Treatment Panel III)
-
The seventh report of the Joint
National Committee on Prevention, Detection, Evaluation, and
Treatment of High Blood Pressure (JNC-7)
-
American Diabetes Association
(ADA) Guidelines
-
American Geriatric Society (AGS)
Clinical Practice Guidelines
-
Beers Criteria for Potentially
Inappropriate Medications Use in Older Adults
Current Medication Therapy
Management / Medication Review Opportunities
Community Care Rx
CCRx MTM Program
(http://www.mirixa.com
or www.ccrx.net)
Click here for additional
resources from Mirixa
Pharmacies in Virginia have recently
received information on the Community Care Rx (CCRx) MTM Services
Program, which is available through a company called Mirixa. This program affords your pharmacy the opportunity to be
compensated for providing MTM services that will positively impact
your patients’ quality of life and possibly reduce their
healthcare costs.
To participate in, receive training
for, or simply learn more about this program, contact Mirixa at (703) 683-1955 or visit
http://www.mirixa.com/. In
order to sign up for this program, you must fill out a contract
with CCRx and Mirixa. Both contracts are available on the
website listed above.
Also offered by CCRx, is a billable
service known as the Welcome to CCRx Medication Reviews: Helping
Your Patients Transition into CCRx. Benificiaries who enrolled
in CCRx during June or after will have a new benefit, the “Welcome
to CCRx Medication Review.” The Welcome Review is a review of all
of the patient’s medications that will be conducted face-to-face
with the patient’s pharmacist. Because the Welcome Review is part
of the CCRx transition process, the service is offered to
beneficiaries free of charge and is voluntary.
Welcome to CCRx
Medication Review
New enrollees to CCRx with
benefit effective dates after July 1, 2006 will have the
opportunity to provide a Welcome to CCRx Medication Review, a
pharmacist-delivered patient care service, to help with their
transition into CCRx and Medicare Part D. While participation in
this new program is voluntary, we hope you will educate your
patients about the benefit of this service, which is billable
for pharmacists and free to your patients.
Pharmacists will be expected
to execute specific tasks to complete the review and bill the
$40 charge using the Mirixa communications
service, a Web-based secure messaging system that is also being
used for the CCRx MTM program.
The core set of activities
and services of the "Welcome to CCRx Medication Review" include:
-
Using the Mirixa system to
identify qualified patients and schedule face-to-face "Welcome
to CCRx" medication review of about 20-minutes duration
-
Asking patients to bring
all of their medications to the review
-
Reviewing the patient’s
medication regimen and educating the patient about their
medications and/or intervene as clinically appropriate
-
Comparing the patient’s
current medications with the CCRx formulary and identifying
cost-saving opportunities for therapeutic and/or generic
substitution
-
Using the Mirixa system to
document services conducted during the review
-
Using the Mirixa system to
bill for the review service
To contract with Mirixa and
complete the MemberHealth addendum to provide CCRx patient care
services, please visit the
Mirixa Web site
and click on the link "Join Our Network." Follow the
instructions to view the service agreements and complete the
short form. A representative from Mirixa will contact you to
verify your information and give you your unique login/password
to access the application, which includes training on using the
Mirixa web application. If you are a member of a buying group or
third party contracting entity, please check with them to see
if they are contracting on your behalf.
Mirixa Sending
First 2007 Cases to Pharmacies NEW
Mirixa is set to begin notifying Community Care Rx-contracted
pharmacies that they have Part D beneficiaries eligible for MTM
services. Last year more than 44,000 CCRx MTM cases were
delivered using the Mirixa web-based delivery system.
That resulted in payments to community pharmacies of some $1.6
million.
Mirixa has provided a series of upgrades designed to increase the
system's functionality, making it easier than ever before to
view, schedule, and complete MTM cases for eligible CCRx
beneficiaries. Training tools to help pharmacists take full
advantage of the upgrades and new features are on the Mirixa Web
site www.mirixa.com.
Resources from Mirixa
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First Health Select
First Health Select Rx
Checkup
(www.firsthealthpartd.com)
Letter
in PDF format
Patient
Trifold informational packet
Document outlining billing specifics
First Health Select Rx Checkup is a
cognitive service provided by Registered Pharmacists to First
Health Select Medicare Part D members.
First Health Select (FHS) recognizes the important role that
pharmacists can play in patient care. With the extensive
medication knowledge possessed by this profession, and the fact
that our members most likely come in contact with their pharmacist
more often than any other health care professional, we believe
they are an underutilized resource to improve patient outcomes.
How the First Health Select Rx Checkup will work:
-
The FHS member would contact the
pharmacy to schedule an Rx Checkup
-
The Pharmacist sets aside an
adequate amount of time to review the patient’s medication history
as well as interview the patient regarding medical conditions and
OTC medications.
-
The Pharmacist documents this
encounter on the “FHS Rx Checkup Progress Note Form”.
Recommendations for changes in therapy should be included on this
form and faxed back to FHS as well as the patient’s primary care
physician.
Examples of Discussion
Topics/Interventions:
-
Drug-Drug Interactions
-
Drug-Food Interactions
-
Drug-Disease state interactions
-
Duplication of therapy
-
Low dose/High dose alerts
-
Therapeutic substitution opportunity
-
Side effect counseling
-
Proper Medication administration
(time of day, with or without food, dosing intervals, etc)
-
Confirm patient understands what
each drug is being used for
-
Recommendations consistent with
national guidelines (Post MI not on a beta blocker, etc)
-
Suggested lab testing
-
Overuse and potential abuse issues
-
Patient compliance
-
Other clinically appropriate
interventions/prescriber consultation
This counseling session will allow
pharmacists to take a break from the dispensing role and use their
expertise to improve patient outcomes.
This service will be paid for by First Health Select once per
member per calendar year at
the rate of $30 per Rx Checkup.
Pharmacies in need of technical
assistance, call Caremark Pharmacy Provider Help Desk at
1-800-421-2342.
Pharmacies looking for more information on becoming a First Health
Part D or AdvantraRx pharmacy provider, contact Maria Scalise,
Director of Pharmacy networks at 412-553-7548.
Humana
Humana MTM program
(www.humana.com/pharmacists)
Check back for updates on
Humana's 2007 MTM Program
Click to go back
Outcomes Pharmaceutical Health Care™
Outcomes™ Announces Medicare MTM Program in Virginia
DES MOINES, IA (January 31,
2007)—Outcomes Pharmaceutical Health Care™ (Outcomes™) has been
selected by Optima Health Plan, a service of Sentara Healthcare,
to administer the Medication Therapy Management (MTM) services
component of the 2007 Optima Medicare Part D prescription drug
plan in the state of Virginia.
Under the program, eligible members will receive MTM services from
specially trained Personal Pharmacists™ to help them achieve safe
and effective results from their medications while controlling
costs. Optima is the seventh such Medicare Part D plan to contract
with Outcomes for MTM services.
Among the new services available to program enrollees is an annual
Medication CheckUp™ which allows members to meet one-on-one with a
pharmacist in their area. The pharmacist will review the patient’s
complete medication profile to detect any potential conflicts or
duplications. Additional services such as patient education,
compliance monitoring, and assistance with non-prescription
medications will also be available.
Pharmacists or pharmacies who are interested in participating with
Optima or other Outcomes administered MTM programs should call
515-237-0001 or visit
www.getoutcomes.com.
The Optima plan is available within Medicare’s MA Region 7. For
more information visit
www.optimahealth.com/optimahealth.
Outcomes™ Increases MTM Payment Rate To Pharmacies
Payment increase the first of
many new enhancements for 2007
DES MOINES,
IA (January 4, 2007) - Outcomes Pharmaceutical Health Care™
(Outcomes™) has announced an increase in payments to
pharmacies for the provision of covered Medication Therapy
Management (MTM) services.
Effective
January 1, 2007, the base Medication Check-Up™ payment for
most Outcomes plans will increase from $30 to $50. The
increase follows an internal company analysis that once again
demonstrated high value in face-to-face MTM services. Claims
data was reviewed going back to 2003 and it was found that an
estimated $600 was saved in avoidable prescription drug,
medical and hospital costs for each covered patient who
received the Medication Check-Up service.
“This payment
increase was earned by our network pharmacists,” said Outcomes
CEO, Tom Halterman. “Analyses of MTM service claims confirm
that positive results occur when pharmacists provide
face-to-face MTM services to covered patients,” he added.
Halterman noted that the payment increase was the first of
many program enhancements in-store for 2007.
The
Medication Check-Up service consists of an appointment-based
comprehensive medication review between a pharmacist and a
covered patient to assess and organize the patient’s
medication regimen. In addition to the $50 base fee,
participating pharmacists may earn additional fees for
resolving medication-related problems, complications or cost
savings opportunities discovered before, during or after the
review.
John Deere Health Care Medicare MTM
Program
(www.getoutcomes.com)
Letter in PDF format
John Deere Health Care has elected
to utilize community pharmacists as providers of Medication
Therapy Management (MTM) services in its Medicare Prescription
Drug Plan. A subgroup of plan members is eligible for a full menu
of face-to-face MTM services, including plan-initiated services
(Automated Encounters) and pharmacist-initiated services. This
community pharmacy-based MTM program is administered by Outcomes
Pharmaceutical Health Care.
Covered Services – Plan-Initiated (Automated Encounters)
This packet includes one or more pre-identified opportunities to
get started today in providing MTM services to eligible John Deere
Health Care Medicare members. These pharmacy- and patient-specific
Automated Encounters should be completed, as appropriate, and
faxed to Outcomes (515-237-0002). No additional contracting or
training is required. See Automated Encounter forms in this packet
for more information.
Covered Services – Pharmacist-Initiated
In addition to Automated Encounters, pharmacists may bill for the
provision of many other services to MTM-eligible John Deere Health
Care Medicare members. The covered services, and the corresponding
professional fees, appear below:
-
Comprehensive Medication Reviews (CMR)
$30.00
-
Physician Consultations $20.00
-
Patient Compliance Consultations
$20.00
-
Patient Education & Monitoring
$10.00
To be eligible to provide these
pharmacist-initiated MTM services and receive professional fees,
pharmacists must complete the Outcomes Personal Pharmacist
Training program. Training may be completed online (available at
www.getoutcomes.com) or
via CD-ROM.
Eligible Patients
To obtain a list of the John Deere Health Care Medicare
MTM-eligible patients at your pharmacy, contact Outcomes at
515-237-0001 or
info@getoutcomes.com.
Outcomes Pharmaceutical Health Care Background
Outcomes has administered community pharmacy-based MTM programs
since 1999. Seven years of experience have allowed Outcomes to
build a nationwide network of “Outcomes Personal Pharmacists” that
includes over 5,000 pharmacists. Outcomes works with Medicare
plans, Medicaid, self-insured employers, pharmaceutical
manufacturers, and others to improve quality of care and reduce
costs for MTM-eligible patients. Over 65,000 MTM claims have been
submitted in Outcomes-administered programs.
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