Medication therapy management — the pharmacist consultation most people don't know about

This article provides information about medication therapy management services. MTM consultations are often free or low-cost for eligible patients. Ask your elder's pharmacist or healthcare team whether they qualify.

There's a free or low-cost service available to many older adults that few people know about. It's called medication therapy management, often abbreviated MTM. A pharmacist spends an hour with your elder reviewing all their medications, looking for interactions, identifying problems, and making recommendations to improve medication safety and effectiveness.

Many older adults take multiple medications. They might be prescribed by different doctors who don't always coordinate. Sometimes medications are duplicative. Sometimes they interact. Sometimes doses aren't right for someone with kidney or liver problems. Sometimes side effects are actually from drug interactions rather than the medications themselves. A pharmacist trained in medication therapy management looks at the whole picture.

Who qualifies for MTM? It's available through Medicare Part D for people on multiple medications with multiple chronic conditions spending significant amounts on medications. Some state Medicaid programs offer it. Some insurance plans offer it. Some pharmacies offer it without insurance coverage. The eligibility criteria vary, but many people qualify.

How does MTM work? It usually starts with your elder's pharmacist asking if they're interested. The pharmacist schedules a consultation, often an hour long. During this time, the pharmacist reviews all of your elder's medications including prescription medications, over-the-counter medications, and supplements. They look at why each medication was prescribed. They identify any potential interactions or duplications. They assess whether doses are appropriate for your elder's age and kidney function.

The pharmacist asks questions about your elder's health conditions, daily routine, any concerning symptoms, medication side effects, medication adherence, and preferences. They take notes on your elder's goals for treatment.

After the consultation, the pharmacist creates a medication action plan. This document lists all medications, the purpose of each, potential interactions, any concerns, and recommendations. Recommendations might include simplifying the medication regimen, addressing side effects, improving adherence, or suggesting a conversation with the doctor about medication changes.

The pharmacist provides this action plan to your elder and sends it to their doctor. The idea is that the doctor considers the pharmacist's recommendations and makes changes if appropriate.

The value of MTM comes from the pharmacist's expertise. They know more about drug interactions than most doctors. They know which side effects are common and which might be drug interactions. They know dosing adjustments needed for age, kidney function, or liver function. They understand medication adherence challenges and can suggest solutions.

A common finding in MTM is that a patient is having side effects from drug interactions, not from any individual medication. For example, your elder might be taking a medication that raises blood pressure combined with another that lowers potassium. The combination causes symptoms. Changing one or both medications solves the problem.

Another common finding is duplicate therapy. Your elder might be taking two different medications from the same class. Maybe one was started by a cardiologist and another by a primary care doctor who didn't know about the first. The pharmacist identifies this and recommends discussing with the doctor about stopping one.

Sometimes medications are prescribed but no longer needed. Your elder might be on blood pressure medication when their blood pressure is controlled and hasn't been checked in years. The pharmacist might recommend discussing whether it's still necessary.

Medication adherence is another focus. If your elder struggles to remember to take medications, the pharmacist might suggest once-daily formulations instead of multiple daily doses. Or a pill organizer. Or phone reminders. Anything that helps your elder actually take medications as prescribed.

Cost is sometimes a barrier to adherence. Your elder might take less medication than prescribed because of cost. The pharmacist knows about patient assistance programs, generic options, and discount programs. They might identify ways to reduce cost.

Finding MTM is sometimes a matter of asking. Your elder's pharmacist might know about it. Their insurance company's website might list it. Their doctor might refer them. Some community health centers offer it. Some universities with pharmacy programs offer it.

If your elder qualifies, there's usually no cost to the patient, though some programs charge a small fee. Medicare covers MTM for eligible beneficiaries. Insurance or Medicaid covers it for qualifying patients. The pharmacist's time is paid by the insurance plan or healthcare system, not by your elder.

After the consultation, your elder should discuss the pharmacist's recommendations with their doctor. Good doctors take pharmacist recommendations seriously. Some might adjust medications based on these recommendations. Some might explain why they prefer to keep things as they are. Either way, the conversation is valuable.

Follow-up is important. Some MTM programs include a follow-up visit three months later to see how things are going. Has the medication regimen improved? Are there new concerns? This allows for refinement.

MTM is particularly valuable for someone on many medications from multiple doctors. It's valuable for someone having unexplained symptoms. It's valuable for someone struggling with medication costs. It's valuable for someone concerned about medication interactions.

Your role is encouraging your elder to use this service if they qualify. You might attend the consultation with them and help take notes. You might help them discuss recommendations with their doctor. You might help them implement changes.

The pharmacist's goal is the same as yours: helping your elder stay as healthy as possible while managing their medications safely and effectively.

If your elder takes multiple medications or has multiple chronic conditions, ask whether they qualify for medication therapy management. If they do, encourage them to schedule a consultation. Discuss the pharmacist's recommendations with their doctor. Remember that pharmacists are medication experts and their recommendations often improve medication safety and effectiveness.