If you’re an older adult, one of the most frustrating aspects of everyday life may be staying on top of all those medications you’ve been prescribed. Making sure they’re in the right slot in your pillbox can be frustrating. In some cases, because you’ve been prescribed so many different drugs, you may wonder if you still need to be taking them all. In other cases, you may be experiencing unwanted side effects. Keeping up can feel like a full-time job.
But it doesn’t have to be that way. In fact, if you’re enrolled in Medicare — and have opted for monthly Part D prescription drug coverage — you could have some major help coming your way.
Nearly two decades ago, Medication Therapy Management (MTM) programs were recognized when the Medicare Prescription Drug, Improvement, and Modernization Act was passed.1 It pairs Medicare participants with a pharmacist (or a qualified healthcare provider) for an annual review of the participant’s medications, referred to as a MTM review. This provision is designed to ensure that patients get the most out of their medications while reducing their risk of adverse drug events. Plus, it can help identify if a patient can reduce medication-related costs.2
Below, find out whether you’re eligible for an MTM review, and if so, everything you need to know to make the most of your next medication review.
Who has access to the annual medication management program?
If you’re on Medicare, have Part D coverage, and qualify for certain criteria, you’ll be eligible for a MTM review, says Darrell Hulisz, R.Ph., Pharm.D., who serves as an associate professor in the Department of Family Medicine and Community Health at Case Western Reserve University School of Medicine in Cleveland.
“To be eligible, patients must have more than one chronic disease, take multiple Part D drugs, and typically incur annual costs for covered Part D drugs that are greater than or equal to the specified MTM cost threshold for the specific year,” Hulisz says.
The requirements are subject to change on an annual basis and vary slightly depending on your insurance plan’s rules. “These requirements can be complicated,” says Hulisz. It’s always a good idea to get clarification from your insurance provider on whether or not you qualify for MTM services under your specific plan.
That said, most plans specify the same set of health conditions for patients who frequently take multiple drugs. These may include, but are not limited to3:
- Asthma
- Bone conditions, such as osteoporosis
- Chronic heart failure
- Chronic obstructive pulmonary disease
- Diabetes
- High blood pressure
- High cholesterol
- Mental health conditions, such as depression, schizophrenia, bipolar disorder, or other chronic and disabling mental health conditions4
What are some problems medication management reviews seek to solve?
There’s one overall goal with a MTM review, says Zachary A. Marcum, Pharm.D., Ph.D., an associate professor in the School of Pharmacy at the University of Washington in Seattle. “It’s meant to improve the health of older adults by optimizing the medications they take,” he says.
If you have multiple health issues, or if you’re taking multiple medications over a period of time, three medication issues could arise and lead to problems for you. These are:
- Underuse. “You may have a condition for which there’s good evidence that a particular medication can help, and for some reason it isn’t being used,” says Marcum. During a MTM review, you may learn, for example, that a recommended drug can alleviate a problem you’ve been dealing with.
- Overuse. You may be taking a particular medication that you no longer need to be taking because you’ve recovered from whatever it was treating, says Marcum.
- Inappropriate use. You may be taking a medication that has risks that outweigh its benefits in your specific situation, says Marcum.
By reviewing underuse, overuse, or inappropriate use of medications, medication management services can allow for optimization of your medication plan. Remember, you should always consult your doctor before stopping or starting medication. If you’re experiencing any unwanted side effects, call your doctor.
Who offers Medicare’s MTM program?
If you’re looking to do an annual medication review, it will start with either a registered pharmacist or your doctor, and that person could even be the one you know and interact with regularly at your local pharmacy, says Hulisz.
That said, you might also see a pharmacy intern or technician — both of whom are qualified to oversee the program too. Know that they’ll be doing it under the watchful eye of your pharmacist.
In some cases, you might not even have to leave your house to complete your review. “You may receive a call from your pharmacy asking you to complete an MTM over the phone,” says Hulisz.
How can you get the most out of your MTM review?
Remember: medication management is meant to help you get the most out of your current prescription drug regimen. So during your MTM review, you’re entitled to ask your pharmacist — or whomever is overseeing the review — questions about what you’re taking and how those medications work to your benefit.
But that also means you should do a little homework before going to your local pharmacy or jumping on the phone with a pharmacist. Prepare yourself as best you can to take an active role in the conversation.
Have a list of all the medications, vitamins, and supplements you’re taking handy. Even if you’re working with your local pharmacist, they may not know everything you’re taking, especially if you use more than one pharmacy.
Once you have that list together, here are some important questions to ask during your review:
1. What am I being treated for, or what condition is being managed with each of my medications?
You may feel you know which medication is for which condition, but it’s worth reviewing it with an expert like your doctor or pharmacist.
2. Am I taking any medications that I don’t need to be taking anymore?
“It may be possible to deprescribe some medications,” says Marcum. (Deprescribing is when you stop taking a medication under the supervision of a medical professional.5) For example, during the annual review, your pharmacist may recommend to your healthcare provider that one of your drugs be deprescribed.
Deprescribing can be especially relevant for patients taking five or more prescriptions, which is also known as polypharmacy.6 However, this decision isn’t always clear-cut, and your doctor will want to weigh the advantages and disadvantages of keeping you on a specific drug or taking you off of it.
3. Are there ways to reduce the cost of my medications?
“You may not think that’s possible at first, but it often is,” says Marcum. For example, there may be a generic, less expensive version of a pricey drug you’re taking. Your pharmacist may also offer or accept coupons. The only way to know is to ask.
4. Are any of my medications interacting with one another — or my genes?
Describe any side effects you may be having while taking your drugs. You could be experiencing a drug-drug or gene-drug interaction. Some drugs interact poorly with other ones, causing unwanted or potentially harmful side effects. In those situations, you can ask your pharmacist or doctor whether they can make changes to your prescription drug regimen.
In the case of gene-drug interactions, your local pharmacist or doctor may not have the tools at their disposal to assess these potential interactions. Through precision medicine techniques used by companies like Genomind, they can prescribe drugs and dosages that may be less likely to interact with your genes.
5. Is there a way that my doctor or pharmacist can simplify my dosing schedule?
“A patient may be taking meds four or five times a day, which can be burdensome, but there are often ways to make things easier,” says Marcum. Within classes of drugs, there may be some that need to be taken once a day and others that are twice daily, he explains. You may be able to switch to a once-a-day option.
You can also ask if you need to take certain drugs at specific times. “Some patients take their meds at a certain time of day because they think they have to, and for the majority of drugs, it may not matter,” says Marcum. That may help you break up the amount of medications you’re taking over the day, so you don’t have to take as many at a single time.
6. Can you help me make a medication list or calendar?
At the end of your MTM review, ask the person overseeing it if they can help you make an updated list of your prescription drugs, what they’re for, and when you should take them. This can ensure that you, your caregiver(s), and your healthcare professionals have the most updated information regarding your medications.
The importance of medication management
“Remember that the goal of this review is to help you better understand and manage your health,” says Hulisz. So don’t just print out this story and ask these six questions; feel free to ask your pharmacist or whomever is overseeing your MTM review whatever is on your mind. If you’d like, take notes — or bring a trusted friend or family member to record the interaction in some way — so that you can reflect on what you’ve been told and follow up with your doctor later.
Whether you’re eligible for a MTM review or not, it’s always a good idea to keep a running list of the medications, vitamins, and supplements you’re taking so you can ask your doctor or pharmacist about them when you have your next appointment.
Sources
- Information about Medicare and medication review: Medication Management Therapy (2022)
- Background on MTMs: Medication Therapy Management programs for complex health needs (2022)
- Conditions that qualify for an MTM: Medication Therapy Management (MTM) Program (2021)
- Mental health conditions that qualify for an MTM: CY 2020 Medication Therapy Management Program Guidance and Submission Instructions (2019)
- Definition of deprescribing and how it works: Deprescribing: a primary care perspective (2017)
- Information on polypharmacy: Polypharmacy: Evaluating Risks and Deprescribing (2019)
