CMR: Beyond the brown-bag review

The comprehensive medication review (CMR) offers much more than the traditional brown-bag review. Pharmacists go beyond review of medication purposes and side effects, and creation of a personal medication list (PML) for the patient. CMRs also assess issues such as adherence, appropriateness of therapy, and opportunities for cost savings, and along with a medication list provide a medication action plan (MAP), detailing the steps to optimized medication therapy. The focus is no longer on just the bag of medications, but on the care of the patient as a whole.

Patients may be referred to this service by their doctors or health insurance plan, or they may self-refer. A pharmacist may initiate a CMR by contacting an eligible patient and scheduling a 30- to 60-minute appointment.

If information is available, the pharmacist may begin to review the patient's therapy before the appointment. Nonetheless, requesting that patients bring either a list or their actual medications, including all prescriptions, over-the-counter drugs, vitamins, and herbal products, can help ensure an accurate and thorough review.

In spite of their training as medication therapy experts, pharmacists often hear this phrase from patients who don't understand the benefits of CMR services. To encourage participation, pharmacists must provide information that patients want.

For instance, knowledge of comparable generic products and the potential for money-saving options can be a selling point for many patients hoping to decrease their out-of-pocket costs.

It's also important to let patients know that the CMR will be used to supplement the care that they are already receiving and changes will not be made without both their and their doctor's agreement.

Elements of CMR

While there is no strict formula, a complete CMR includes:

Reaching out to patients

The Affordable Care Act now specifies that an annual CMR will be provided as part of all Medicare Part D programs.

In 2012, many plans will offer a complimentary CMR to newly enrolled patients, which will provide pharmacists with new opportunities to reach out to their patients. The Centers for Medicare and Medicaid Services (CMS) have proposed inclusion of 3 components in this review: a beneficiary cover letter, a MAP, and a PML.

A standardized MAP will be developed and implemented in 2013.

More to come

This isn't all that's out there for CMRs. Tools for helping to structure and efficiently complete a CMR have been developed.

For example, United Way of Dane County, Wisc., and the Wisconsin Pharmacy Quality Collaborative will be using Aprexis Health Solutions' web-based platform as part of United Way's Safe and Healthy Aging Community Project. Dane County pharmacists seeking to reduce adverse drug events and address adherence issues in seniors will be reimbursed when they use this tool to provide medication review services to eligible seniors.

Bottom line

Medication therapy management services are at the forefront of methods expected to move the pharmacy profession forward, and CMRs are part of the mix. The value offered by use of CMRs is twofold: Patient care improves, while pharmacists receive recognition and compensation for use of skills and knowledge that are already part of the pharmacy toolkit.

Abigail Johnson is a PGY-1 community pharmacy resident, University of Wisconsin School of Pharmacy. Contact her at arjohnson1@wisc.edu
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