Key Terms
Telepharmacy
Provision of pharmacy services by pharmacists to patients or caregivers using technology
MTM
A program requiring plan sponsors offering Medicare Part D to provide pharmacist-driven services targeting optimization
Eligible members must meet ALL THREE
1. Multiple chronic diseases 2.
METHOD
Providers use pharmacy AND medical claims data to identify eligible members.
Improvement)
1. Improve patients' care experience 2.
MTM (Medication Therapy Management)
Structured pharmacist-driven program targeting optimization of therapeutic outcomes and reducing adverse events; require
CMR (Comprehensive Medication Review)
Annual, full medication review required under MTM programs
TMR (Targeted Medication Review)
Quarterly focused medication review required under MTM programs
MCO (Managed Care Organization)
Insurance entity that provides telepharmacy/MTM services to members
PBM (Pharmacy Benefit Manager)
Organization that manages prescription drug benefits; can provide MTM services
CMS (Centers for Medicare and Medicaid Services)
Federal agency that sets MTM requirements and performance metrics for Part D plans
PQA (Pharmacy Quality Alliance)
Organization whose MTM Completion Rate CMS adopted as the Part D sponsor performance metric
Triple Aim
IHI framework — improve care experience, improve population health, reduce per capita cost
SDH (Social Determinants of Health)
Non-medical factors (income, location, transportation, housing, education) that affect health outcomes
Pharmacy Desert
A geographic area where no pharmacy services are available