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Medication Literacy Series: Medication Management

 

“Medication management” is an inclusive term that describes the motivations and means that individuals use to coordinate their medication regimens meaningfully and accurately. For older adults, 40 percent of whom take five or more medications daily, medication management is a fundamental activity for coordinating daily medications. Medication management can take a variety of forms, from a formal program with structured interventions and clearly defined outputs to informal tools and strategies used to facilitate self-management.

Research has repeatedly shown that when older adults effectively manage their medications, they can prevent adverse events and improve health outcomes. Yet many older adults do not participate in formal, health care provider–led medication management programs that conduct a comprehensive review of all medications and generate a standardized action plan, and they may also lack access to other helpful innovations, tools (e.g., pill organizers and blister packs), and strategies (e.g., written medication routines).

This fact sheet explores the range of formal medication management programs that are available and the challenges that older adults, especially those with limited medication literacy—the ability to obtain information about medication, process it, and use the information to make medication decisions—and their family caregivers face when trying to manage their medications.  

Medication therapy management (MTM)

MTM is a broad range of health care services that help optimize prescription drug therapy. MTM brings together pharmacists, providers, and patients to resolve and prevent medication related problems and improve medication use. The model MTM program includes a core set of services and products: medication therapy review, an up-to-date personal medication record, a medication action plan, necessary interventions, and documented follow-up.

Medicare – Medicare’s MTM program offers participants an annual, real-time consultation with a pharmacist or their representative (comprehensive medication review, or CMR); quarterly interventions that focus on identified or potential medication issues (targeted medication reviews, or TMR); and a formal, written action plan. Medicare Part D plans set MTM eligibility criteria to target beneficiaries who are at highest risk of adverse medication events, and plans have the flexibility to go beyond the minimum standards and offer MTM to more enrollees. Enrollment in Medicare MTM has remained historically low, however, and CMS recently proposed new criteria to address low enrollment, which may also help address longstanding racial and ethnic disparities in Medicare MTM utilization.

Medicaid – Federal law neither requires that states provide, nor sets the conditions for, Medicaid MTM, and data on such programs remain limited. As of 2020, 11 state Medicaid programs offered MTM and nine additional state Medicaid programs offered at least one MTM component. Each of the states has used a combination of state laws, agency regulations, and MTM best practices to guide the delivery and assessment of MTM services. Like in Medicare, Medicaid’s MTM program is available to a limited number of beneficiaries. While all states have designed eligibility criteria to target a subset of enrollees—those who are at highest risk for medication-related problems—the state approaches differ. 

Beyond MTM, providers, insurers, and vendors have operationalized several other medication management interventions, such as comprehensive medication management (CMM), which is a formal medication program that has a broader focus and more expansive goals than MTM.

Patient contributions to medication management

Whether an older adult participates in a formal medication management program or a less formal intervention or self-manages their medication, they must be able to perform a set of actions to organize their medication therapy. To manage medications effectively, an older adult must employ certain skills or strategies. These may include basic skills (e.g., reading medication labels, comprehending instructions for use, and ordering refills), interpretive skills (e.g., knowing how to take appropriate action when a medication-related problem emerges), and integrative skills (e.g., adopting strategies to organize medications into a daily routine).

Yet not all older adults are able to employ these skills; research has shown that people with reduced cognitive functioning and people in older age groups face the most difficulty. These same challenges extend to family caregivers as well.

Limited medication literacy—a subset of health literacy that considers an individual’s ability to obtain information about medication, process it, and use the information to make medication decisions—may also diminish an older adult’s capacity to manage medications effectively. One study found thirty-four percent of adults ages 50 to 64, and 59 percent of adults ages 65 and older, had limited literacy levels and may lack the foundational skills to perform basic management tasks, such as locating information on a drug label. Medication management interventions may be particularly helpful for older adults and family caregivers with limited medication literacy. Older adults enrolled in formal medication management programs may have access to and benefit from tools that account for varying literacy levels. Further, many participating health care providers receive training in how to tailor MTM services to enrollees with limited literacy and they may also use specifically designed resources that target limited-literacy enrollees.

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Conclusion

Older adults, in coordination with their family caregiver or other representative, can personalize their medication management process using the tools available to them and in a way that best suits their needs. Whether an older adult follows the formal protocols of a medication management program, uses targeted interventions, or incorporates tools and strategies into a system of self-management, they create a process that will help them manage their drugs and remain healthy. Key to the success in each approach is knowledge of and access to programs and tools that support and encourage effective medication management.