Download this issue brief as a PDF to save and print.

References are located at the bottom of this page.

Patients With Psychiatric Disorders Have Complex Medical Needs CPNP Urges CMS To Pay For Comprehensive Medication Management (CMM) Provided By Psychiatric Pharmacists What Can Congress Do? Enact legislation to cover Comprehensive Medication Management (CMM) by psychiatric pharmacists for Medicare beneficiaries with complex medical needs under Medicare Part B. PSYCHIATRIC PHARMACISTS ARE UNDERUTILIZED EXPERTS IN PSYCHOPHARMACOLOGY Improve Patient Outcomes and Reduce Health Care Costs WHO THEY ARE Advanced practice, clinical pharmacists who specialize in optimizing medications for people living with mental health (MH) and substance use disorders (SUDs) Increase capacity of the health care team to care for patients with psychiatric and substance use disorders as well as improve patient outcomes and reduce overall health care costs Extensive knowledge of medications plus skill in treating the whole patient WHAT MAKES THEM UNIQUE WHERE THEY PRACTICE Multiple practice settings including public, private, outpatient, inpatient Include psychiatric pharmacists on the health care team working in collaboration with the patient and other health care providers including psychiatrists, other physicians, therapists, social workers, and nurses HOW TO USE THEM 60% of early mortality is due to inadequately treated medical conditions There is a 2-3X higher mortality rate in individuals living with serious mental illness (SMI), dying 13-30 years earlier than individuals in the general population Higher rates of obesity, heart disease, and diabetes often result from adverse eects of psychiatric medications FACT: People living with mental illness have high rates of morbidity and mortality, frequently caused by modifiable risk factors1 FACT: People living with SMI have higher readmission rates resulting in increased health care costs2 23.1% with SMI have a medical readmission within 30 days vs 13.8% without SMI 19.3% WHY USE THEM with SMI have a surgical readmission vs 9.4% without SMI 61 million seniors and people with disabilities enrolled in Medicare Part B currently have no access to CMM services that could advance achievement of the quadruple aim Only 10% of Medicare Part D beneficiaries receive covered Medication Therapy Management (MTM) services3 and these services are limited in scope, medication centered, and indirectly delivered Patient access to psychiatric pharmacists' services, including CMM, is currently limited by CMS' lack of recognition of pharmacists as providers which severely limits mechanisms for payment for these services Psychiatric Pharmacists Address Obstacles and Bridge the Gap as important members of the health care team, by providing expert, evidence-based CMM services for the most complex patients with mental health and substance use disorders. This can only happen if these services are covered and psychiatric pharmacists are reimbursed. Obstacles Built Into The System ADVOCACY ISSUE BRIEF CPNP Urges CMS To Pay For Comprehensive Medication Management (CMM) Provided by Psychiatric Pharmacists Psychiatric Pharmacists, As Part Of The Health Care Team, Use The Process Of CMM4,5 To: ADVOCACY ISSUE BRIEF CMM Services Provided By Psychiatric Pharmacists Benefit Patients: Assess all of a patient’s medications– prescription, nonprescription, vitamins, and supplements Assess each medication to ensure that it is appropriate, effective, safe, and can be taken as intended Identify and address medication-related problems Develop individualized care plans with therapy goals and personalized interventions Prescribe medications and order laboratory or other diagnostic tests (varies by state) Follow up to evaluate response, adverse eects, progress toward treatment goals, and to adjust medications as needed Educate patient and family about medications and lifestyle modifications Refer to other providers and specialists for services such as diagnostic clarification, psychotherapy, and dietary counseling Needing complex care coordination between multiple providers With multiple chronic conditions On complex medication regimens Who are not meeting treatment goals Who have serious medication adverse eects Transitioning between health care settings Taking clozapine or long-acting injectable antipsychotic medications Who would benefit from genetic testing to optimize their medication regimen With tobacco, alcohol, opioid, or other substance use disorders (SUDs) who may benefit from medication treatment Receiving antipsychotic medications as children The College of Psychiatric and Neurologic Pharmacists (CPNP) is a professional association representing psychiatric pharmacists nationwide. Our members integrate into teams of health care professionals, making a difference in overall costs, treatment efficiencies, patient recovery, and quality of life. References available at: https://cpnp.org/advocacy/cmm CPNP Brenda Schimenti, Executive Director 8055 O St, Ste S113, Lincoln, NE 68510 t:402.476.1677 bschimenti@cpnp.org Focuses on medication instead of targeting treatment goals or outcomes Typically completed by a pharmacist working for the plan, unknown to the patient and provider Patient eligibility criteria vary from plan to plan Typically only targets poor adherence, duplications of therapy, and/or missing medications based on disease state Usually completed by phone not allowing for important in-person assessment FACT: Seniors take a large numbers of medications, leading to frequent drug interactions and adverse eects6 6.3 is the average number of medications FACT: Medicare Part D Covered Medication Therapy Management (MTM) is Not Enough7,8 56.7% of CMS beneficiaries are on 5 or more medications FACT: CMM Results In Improved patient satisfaction Improved outcomes Improved quality of care Better care Reduced costs Improved access to care Improved provider work life Often done without access to patients’ medical records or clinical data making the assessment incomplete Follow-up is missing with recommendations faxed to provider to implement

References

  1. De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52-77. DOI: 10.1002/j.2051-5545.2011.tb00014.x. PubMed PMID: 21379357. PubMed Central PMCID: PMC3048500.
  2. Germack HD, Noor-E-Alam M, Wang X, Hanrahan N. Association of Comorbid Serious Mental Illness Diagnosis With 30-Day Medical and Surgical Readmissions. Jama Psychiatry. 2019;76(1):96-98. DOI: 10.1001/jamapsychiatry.2018.3091. PubMed PMID: 30476934.
  3. Stuart B, Hendrick FB, Shen X, Dai M, Tom SE, Dougherty JS, et al. Eligibility For And Enrollment In Medicare Part D Medication Therapy Management Programs Varies By Plan Sponsor. Health Aff (millwood). 2016;35(9):1572-80. DOI: 10.1377/hlthaff.2016.0258. PubMed PMID: 27605635.
  4. National Board of Medication Therapy Management, Thomas, D. & Tran, J. (2020, September 1). Medication Therapy Management. National Board of Medication Therapy Management https://www.nbmtm.org/mtm-reference/comprehensive-medication-management-versus-comprehensive-medication-review/
  5. PCPCC Medication Management Task Force. (2012). Integrating Comprehensive Medication Management to optimize patient outcomes resource guide. https://www.pcpcc.org/sites/default/files/media/medmanagement.pdf 
  6. Ellenbogen MI, Wang P, Overton HN, Fahim C, Park A, Bruhn WE, et al. Frequency and Predictors of Polypharmacy in US Medicare Patients: A Cross-Sectional Analysis at the Patient and Physician Levels. Drugs Aging. 2020;37(1):57-65. DOI: 10.1007/s40266-019-00726-0. PubMed PMID: 31782129.
  7. Viswanathan M, Kahwati LC, Golin CE, et al. Medication Therapy Management Interventions in Outpatient Settings [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Nov. (Comparative Effectiveness Reviews, No. 138.) Discussion. Available from: https://www.ncbi.nlm.nih.gov/books/NBK294491/
  8. Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. IPRP. 2020;Volume 9:71- 81. DOI: 10.2147/IPRP.S179628. PubMed PMID: 32309200; PubMed Central PMCID: PMC7136570.
25 Years!