Medication therapy management

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Medication therapy management, generally called medicine use review in the United kingdom, is a service provided typically by pharmacists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. [1] This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. [2] The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up. [3] [4]


The medication therapy review has the pharmacist review all of the prescribed medications, any over the counter medications, and all dietary supplements an individual is taking. This allows the pharmacist to look for any duplications or dangerous drug interactions. [5] [6] This service can be especially valuable for people who are older, have several chronic conditions, take multiple medications, or are seen by multiple doctors. [7] [3] [4]

United States

In 2014, the US Centers for Medicare and Medicaid Services required Part D plans to include these services, [8] which led to an expansion of services offered. [9] It is a free service for members enrolled in Part D who meet three eligibility criteria. Enrollees must have at least two chronic conditions, take multiple drugs covered by Part D, and are predicted to exceed a preset amount in annual out of pocket costs for their covered Part D drugs (set at $3,967 in 2018 and $4,044 in 2019). [10] [11]

United Kingdom

A medicine use review (MUR) is an advanced service offered by pharmacies in the United Kingdom. It is part of the current contract pharmacies hold with the National Health Service (NHS). An MUR is an opportunity for patients to discuss their medicines with a qualified pharmacist. An MUR is a free NHS service that is held in a private consultation room at a local pharmacy. It is not meant to replace the role of the general practitioner but rather provide:

Pharmacies in the United kingdom are paid £28 for each Medicines Use Review undertaken, up to a maximum of 400 per pharmacy, per year. At least 70% of patients must be in one of the four target groups:

The introduction of pharmacists into GP surgeries means that the practice pharmacists can do more to ensure that reviews are carried out where necessary. [13]

Abuse of system

There have been concerns over abuse of the system, whereby multiple pharmacies are using the system to charge the £28 fee for each 10- to 15-minute MUR, and pressuring pharmacists to meet targets for the number carried out, with the review more of a tick-box exercise than a benefit for the patient. There have also been cases of falsification of figures. [14]

See also

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  1. "Pharmacist-Led Medication Therapy Management Innovations". AHRQ Health Care Innovations Exchange. September 9, 2016.
  2. Pellegrino, AN; Martin, MT; Tilton, JJ; Touchette, DR (2009). "Medication therapy management services: definitions and outcomes". Drugs. 69 (4): 393–406. doi:10.2165/00003495-200969040-00001. PMID   19323584.
  3. 1 2 "Medication Therapy Management in Pharmacy Practice Version 2.0" (PDF). American Pharmacists Association and National Association of Chain Drug Stores Foundation. March 2008.
  4. 1 2 "Community Pharmacists and Medication Therapy Management". Centers for Disease Control and Prevention. 18 January 2018. Retrieved 21 July 2018.
  5. "Leadership for Medication Therapy Management Version 2.0" (PDF). The American Pharmacists Association and The National Association of Chain Drug Stores Foundation. March 2008.
  6. "Medication Therapy Management Services". American Pharmacists Association. Retrieved November 20, 2018.
  7. Greer, N; Bolduc, J; Geurkink, E; Koeller, E; Rector, T; Olson, K; MacDonald, R; Wilt, TJ (October 2015). "Pharmacist-Led Chronic Disease Management: A Systematic Review of Effectiveness and Harms Compared to Usual Care [Internet]". VA Evidence-based Synthesis Program Reports. PMID   27252999.
  8. "CMS proposes requiring expansion of Part D MTM benefits". Retrieved 2018-11-21.
  9. Viswanathan, Meera; Kahwati, Leila C.; Golin, Carol E.; Blalock, Susan; Coker-Schwimmer, Emmanuel; Posey, Rachael; Lohr, Kathleen N. (2014). "Executive Summary". Medication Therapy Management Interventions in Outpatient Settings. Agency for Healthcare Research and Quality (US).
  10. "Fact Sheet Summary of 2018 MTM Programs" (PDF). Center for Medicare and Medicaid Services.
  11. "Part D: Getting to Know Medication Therapy Management (MTM)" (PDF). National Council on Aging.
  12. "Medicines Use Reviews (MURs)". NHS Employers. Retrieved 7 May 2019.
  13. "Pilot sees pharmacists play greater clinical role at GP practices in Norwich". Eastern Daily Press. 6 January 2017. Retrieved 16 January 2017.
  14. "Have medicines use reviews come to represent profit over patient care?". The Pharmaceutical Journal. 2013. doi:10.1211/PJ.2013.11124150. ISSN   2053-6186.