Medication Therapy Management: An Opportunity for Health Plans


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In taking a thorough look at medication therapy management (MTM), as we do in our latest e-book and upcoming webinar, it’s important to understand that it’s not necessarily a new topic. MTM initiatives exist today and have for some time. The point we’re making is that ownership and administration of them needs to shift to health plans in order for MTM to have maximum impact.

In 2010, 99.9 percent of MTM programs were provided by pharmacists. However, most of these were/are geared toward maximizing medical prescription utilization rather than optimizing health outcomes. In part, this is because pharmacies lack comprehensive medical information about patients. Similarly, providers’ efforts to effectively deliver MTM programs are limited by their lack of both comprehensive medical records and care coordination as patients move across the continuum of care.

Historically, pharmaceutical companies have focused on just one aspect of MTM: medication adherence. This is because they’ve lost hundreds of billions in revenue due to unfilled prescriptions. To combat this, the industry has spent incredible amounts of money developing solutions — things like packaging designs and patient education programs — often with mixed results.

Combine these factors with the increasing recognition among employers that medication adherence is crucial to maintaining a healthy workforce and keeping overall healthcare costs down, and the need for stronger and more effective MTM programs becomes obvious.

Health plans are the most likely to have the tools needed to optimize health outcomes and lower overall costs through MTM. Yet today, many payer-led programs are extremely basic, involving little more than simple letter campaigns. And the majority of health plan-driven MTM programs generate drug savings but not a full return on investment. Some health plans are incorporating certain components of MTM into programs to reduce hospital readmissions; focusing on member education, adherence, polypharmacy (the use of multiple medications by a single patient) and drug interactions. Despite slow adoption of MTM programs by health plans, industry studies do provide enough evidence to suggest that they are a way to reduce adverse medication events, improve health outcomes and reduce costs, with at least one study reporting an ROI of 3.5:1.

The federal government has recognized the need to support health plans in implementing MTM programs and the information technology required to make them work. In fact, the reform law’s new mandates for medical loss ratios (MLR — something we examined in-depth in a previous e-book and webinar) consider MTM to be an activity that improves healthcare quality and, therefore, something that qualifies as a medical loss expense.

Clearly, there is vast potential for effective MTM programs. There’s no doubt that the need exists to better manage how patients perceive, understand and adhere to their medication regimes and how, with the proper technologies, health plans are ideally positioned to make it happen.

What do you think? Do you agree that better management of patients’ medications is a good idea and something that can significantly improve the cost and quality of care? Are health plans, in fact, the one stakeholder in the healthcare system that can successfully administer these programs?

Eric Demers
Eric Demers is executive vice president and chief strategy officer at MEDecision, a leading provider of collaborative health management solutions. Learn more about MEDecision at Follow the company on Twitter at @MEDecision and on Facebook at


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