Medication Therapy Management
The Medication Therapy Management (MTM) case type can help eligible members
understand their medications and reinforce their knowledge of how to properly take them. It
can prevent potentially harmful drug side effects and drug combinations. In addition, the
medications are reviewed for opportunities to reduce prescription drug costs and help
members get the most from their prescription benefits. The MTM program is a free service for
eligible enrollees. For more information, see Medication therapy management in the Pega
Care Management Business Use Case Guide on the Pega Care Management product page. The following list describes items that are related to the Medication Therapy Management
Microjourney: To track the progress of any Social Determinants of Health (SDoH) issues, and use
SDoH information and activities for optimum health and wellness for members, configure the
settings in Pega Care Management. Medication Therapy Management (MTM) consists of a range of services that are
provided to individual patients to optimize therapeutic outcomes and detect and prevent
costly medication problems. Configure these settings to set the criteria against which
patients who are enrolled in Medicare Part D are evaluated for enrollment in
MTM. In App Studio, you can view the data model for Medication Therapy Management in
Case Types. Click the Data model tab on the Medication therapy
management page. To meet your organization's needs, you can extend rules in MTM such as coverage,
additional questionnaires, and calculation of delay in refills. Do not override any rules for customization. Instead use the extension rules. Configuring Social Determinants of Health
Configuring Medication Therapy Management
Data model
Extending rules in Medication Therapy Management
Rules for extension in MTM
Rule name Purpose Additional information Example CalculateRefillDelayDays The calculation of this rule is based on the system date and the next
refill date. Clients can extend this rule based on their
requirements. Data transform A business organization might want to modify their refill calculation
strategy. CheckMemberPlanCoverage Add a plan in a line of business, other than Medicare. Data transform A business organization might want to include the Commercial line of
business as a check for enrollment in MTM. EvaluateMemberExpenses Evaluate the total expense of pharmacy claims for a member by using
the TotalPaidValue property for the calculation. Data transform A business organization might use the value of the
TotalChargeValue property for a calculation of
the total amount instead of the paid amount. ValidateDuplicateInterventionInListExt Used for additional validation when adding interventions to the
flow. Validate rule Clients might want to configure additional validations, for example,
to validate a duplicate intervention based on the combination of
category and the name of the intervention. ValidateDuplicateBarrierListExt Used for additional validation when adding barriers to the
flow. Validate rule Clients might want to configure additional validations, for example,
to validate a duplicate barrier based on the combination of category and
the name of the barrier. SetSpawnedInterventionAgentData Sets and passes the required values to a business analyst for
creating interventions. Data transform A business organization might want to skip any validation or populate
values for additional fields for intervention creation. InitializeSdohAssessmentDetails Add another questionnaire Data transform In addition to the Social Determinants of Health questionnaire, a
provider might add another survey, for example Health Risk Health Risk
Assessment (HRA) DrugToDrugInteraction Integration for drug-to-drug interaction information. Flows A business organization might integrate with a third-party
application that describes drug-to-drug interactions. What not to do
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