Applying Pharmacy Law to Medication Therapy Management (MTM) to pass the MPJE

Applying Pharmacy Law to Medication Therapy Management (MTM) to pass the MPJE

This blog article highlights some pharmacy laws that apply to Medication Therapy Management. It also includes free MPJE type questions to test your learning.

We will focus on MTM (Medication Therapy Management) so that you won't be ABL (Absolutely Bloody Last) to pass the MPJE and help you get top picks for high paying pharmacist jobs. Once Upon a time, having a pharmacist job that solely focused on MTM seemed as far-fetched as the Jetsons, a futuristic 1960's cartoon, complete with robot maids and flying cars. Just as Siri, the virtual assistant, has made her way on every iPhone in the world and flying cars do exist, so does having a pharmacist job that solely focuses on MTM. MTM is a service provided to patients by a pharmacist, the medication experts on a team of healthcare professionals. 

MTM focuses on:

1. Ensuring that the patient is not on duplicate therapy

2. Ensuring that the patient is taking the medication properly

3. Ensuring that the patient has no gaps in care

4. Reducing the risk of medication-related injury and death to patients

5. Reducing the increased cost to patients, insurance companies, and other affiliates across the board

Most MTM programs base the process of their medication therapy reviews on the Medication Therapy Management Core Elements Service Model Version 2.0, which includes five core elements:

1. MTR (Medication therapy review)

2. PMR (Personal medication record)

3. MAP (Medication therapy action plan)

4. Intervention and or referral

5. Documentation and follow-up 

MTM programs conduct MTR's (Medication Therapy Reviews). During an MTR, a pharmacist looks at the patient's medications as a whole, and the different disease states that the patient has. The MTR usually consists of a check for:

1. Vaccinations

2. Duplications of medications

3. Drug allergies

4. HRM (High-Risk Medications)

5. Adherence to medication

6. Gaps in care

7. Therapeutic dosing

The patient is provided with counseling tips, education about their specific disease states, and interventions to follow up with their doctors. The patient's PMR (Personal Medication Record) is chock full of information about the patient like their med-list, disease states, refill history, doctors, and other information that helps the pharmacist assess the patient properly.

Pharmacists use a MAP (Medication Therapy Action Plan) to formally make suggestions and interventions to optimize the patient's medication therapy. For instance, if a patient has Type 2 diabetes and is on a statin medication and aspirin, and the pharmacist notices that the patient is not taking an ACE/ARB, this is an excellent place for a pharmacist to make an intervention and recommend an ACE/ARB. 

To be an MTM pharmacist, you have to be a registered pharmacist. It is recommended but not required to have a residency. It is also recommended but not required to have a Medication Therapy Management Certificate. Pharmacists can obtain a certificate by completing the Delivering Medication Therapy Management Services course located on the APhA (American Pharmacist Association) website. It Is also recommended but not required for a pharmacist applying for an MTM position to have at least two years of experience as a working pharmacist due to the constant fast-pace patient-pharmacist interaction. Medication Therapy Management pharmacists need excellent communication skills and the ability to probe for information. The MTM pharmacist must quickly analyze the patient's medications, make interventions, and complete the review.

Most Medication Therapy Reviews (MTR) are completed over the phone. This type of interaction is called Telepharmacy. Telepharmacy is the provision of pharmacy services by registered pharmacists through telecommunication. Telepharmacy allows a pharmacist to conduct pharmacy activities without being in a physical pharmacy. Pharmacists can perform Telepharmacy practice via numerous means. In this article, we will focus on telepharmacy as it applies to MTM. 

The Model Pharmacy Practice Act (Model Act) is a model used to help states create rules and regulations for telepharmacy. As the practice of pharmacy advances and the COVID-19 series of events limits healthcare professional and patient access to facilities, telepharmacy may become more common. As the practice of telepharmacy increases, we may see more questions about this type of practice setting on the MPJE. It is important to remember that CMS (Central Management Services) establishes telehealth standards, including pharmacists' requirements to make therapeutic interventions when needed. Following HIPAA (Health Insurance Portability and Accountability Act) guidelines is a huge component of telepharmacy, especially when talking to patients on the phone. A pharmacist cannot see the patient, and anyone can pick up the phone, so verifying the patient's identity is required not to violate HIPAA.

In this article, we went over several components of MTM (Medication Therapy Management) and key terms that you should remember to pass the MPJE. These key terms include The Model Act, CMS (Central Management Services), the organization that sets the standards for telepharmacy, and HIPAA, a vital tool to use in all aspects of pharmacy.

Below are some free MPJE style questions. Answer key is towards the end.

A pharmacist conducts an MTR (Medication Therapy Review) over the phone. The pharmacist verifies the patient by first and last name but does not ask for the patient's birth date or address. The pharmacist notices several problems with the patient's med list, including a history of chronic atrial fibrillation and Type 2 diabetes. The pharmacist thinks that the patient should be on aspirin or an anticoagulant but fails to mention it. The pharmacist also forgot to document her findings.

Question 1

When the pharmacist did not ask for the patient's name, the pharmacist made a violation of:

A.     COBRA

B.     HIPAA

C.    CNA

D.    CMS

Question 2

The pharmacist notices that the patient has a gap in care: she fails to mention it to the patient and fails to document her findings. The MTR (Medication Therapy Review) is not done properly, because making an intervention when needed is a requirement by:

A.     MTR

B.     CNA

C.    Public Aid

D.    CMS

Question 3

The document that used to help states create rules and regulations for the practice of telepharmacy is called:

A.     The MTM service act

B.     The Telepharmacy ACT

C.    CMS

D.    The Model ACT

Answers

Question 1 : B

Question 2 : D

Question 3 : D

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About the author  

Dr. Keneshia Berkley is a senior clinical pharmacist who works in MTM and clinical pharmacy. What she loves most about pharmacy is the encouragement and power that she can give back to the patient with each interaction. Dr. Berkley believes that while you may not be able to cure your patient, you can still make a direct impact in their lives by providing a smile, a kind ear, and being empathetic. A patient may not remember your name, but they will remember how you treat them. So, go out there, be great and, most importantly, show the world what pharmacists are made of!