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S B Haga - One of the best experts on this subject based on the ideXlab platform.
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delivery of pharmacogenetic testing with or without Medication Therapy Management in a community pharmacy setting
Pharmacogenomics and Personalized Medicine, 2021Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Yiling Liu, Deepak VooraAbstract:Objective The delivery of pharmacogenetic (PGx) testing has primarily been through clinical and hospital settings. We conducted a study to explore the feasibility of delivering PGx testing through community pharmacies, a less-studied setting. Methods We conducted a cluster randomized trial of community pharmacies in North Carolina through two approaches: the provision of PGx testing alone or PGx testing with Medication Therapy Management (MTM). Results A total of 150 patient participants were enrolled at 17 pharmacies and reported high satisfaction with their testing experience. Participants in the PGx plus MTM arm were more likely to recall a higher number of results (p=0.04) and more likely to clearly understand their choices for prevention or early detection of side effects (p=0.01). A Medication or dose change based on the PGx results was made for 8.7% of participants. Conclusion Limited differences were observed in the provision of PGx testing as a standalone test or combined with MTM. A limited number of treatment changes were made based on PGx test results. Patient acceptance of PGx testing offered through the community pharmacy was very high, but the addition of MTM did not impact patient-reported perceptions about PGx testing or Medication adherence.
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incorporation of pharmacogenetic testing into Medication Therapy Management
Pharmacogenomics, 2015Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Mahesh J Patel, William E Kraus, Nancy Allen M LapointeAbstract:Aim: To assess feasibility and patient satisfaction with a pharmacist-delivered Medication Therapy Management (MTM) plus pharmacogenetic (PGx) testing service. Methods: Thirty patients from a cardiology outpatient clinic were enrolled to attend two MTM sessions, undergo PGx testing and complete pre- and post-intervention surveys. Outcome measures included duration of MTM sessions, clinical application of test results, self-reported Medication adherence, patient recall of results and perceived value of testing and MTM. Results: Overall, patients were very satisfied with the MTM plus PGx testing service. About half of participants (47%) were able to accurately recall their PGx test results. Comparable to MTM without PGx testing, the first MTM session averaged 40 min and the follow-up MTM session averaged 15 min. Conclusion: PGx testing incorporated into a clinical MTM service offered by pharmacists may be a feasible delivery model and is satisfactory to patients.
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Challenges to integrating pharmacogenetic testing into Medication Therapy Management.
Journal of Managed Care Pharmacy, 2015Co-Authors: S B Haga, N M A Lapointe, Jivan MoaddebAbstract:Some have proposed the integration of pharmacogenetic (PGx) testing into Medication Therapy Management (MTM) to enable further refinement of treatments to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This “enhanced” MTM might also reduce patient concerns about side effects and increase confidence that the Medication is effective, addressing 2 key factors that impact patient adherence: concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. In this commentary, we consider some of the challenges to the integration and delivery of PGx testing in MTM services.
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pilot study incorporation of pharmacogenetic testing in Medication Therapy Management services
Pharmacogenomics, 2014Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Nancy Allen M Lapointe, Mahesh J Patel, William E KrausAbstract:Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered Medication Therapy Management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more Medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.
Jivan Moaddeb - One of the best experts on this subject based on the ideXlab platform.
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delivery of pharmacogenetic testing with or without Medication Therapy Management in a community pharmacy setting
Pharmacogenomics and Personalized Medicine, 2021Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Yiling Liu, Deepak VooraAbstract:Objective The delivery of pharmacogenetic (PGx) testing has primarily been through clinical and hospital settings. We conducted a study to explore the feasibility of delivering PGx testing through community pharmacies, a less-studied setting. Methods We conducted a cluster randomized trial of community pharmacies in North Carolina through two approaches: the provision of PGx testing alone or PGx testing with Medication Therapy Management (MTM). Results A total of 150 patient participants were enrolled at 17 pharmacies and reported high satisfaction with their testing experience. Participants in the PGx plus MTM arm were more likely to recall a higher number of results (p=0.04) and more likely to clearly understand their choices for prevention or early detection of side effects (p=0.01). A Medication or dose change based on the PGx results was made for 8.7% of participants. Conclusion Limited differences were observed in the provision of PGx testing as a standalone test or combined with MTM. A limited number of treatment changes were made based on PGx test results. Patient acceptance of PGx testing offered through the community pharmacy was very high, but the addition of MTM did not impact patient-reported perceptions about PGx testing or Medication adherence.
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incorporation of pharmacogenetic testing into Medication Therapy Management
Pharmacogenomics, 2015Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Mahesh J Patel, William E Kraus, Nancy Allen M LapointeAbstract:Aim: To assess feasibility and patient satisfaction with a pharmacist-delivered Medication Therapy Management (MTM) plus pharmacogenetic (PGx) testing service. Methods: Thirty patients from a cardiology outpatient clinic were enrolled to attend two MTM sessions, undergo PGx testing and complete pre- and post-intervention surveys. Outcome measures included duration of MTM sessions, clinical application of test results, self-reported Medication adherence, patient recall of results and perceived value of testing and MTM. Results: Overall, patients were very satisfied with the MTM plus PGx testing service. About half of participants (47%) were able to accurately recall their PGx test results. Comparable to MTM without PGx testing, the first MTM session averaged 40 min and the follow-up MTM session averaged 15 min. Conclusion: PGx testing incorporated into a clinical MTM service offered by pharmacists may be a feasible delivery model and is satisfactory to patients.
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Challenges to integrating pharmacogenetic testing into Medication Therapy Management.
Journal of Managed Care Pharmacy, 2015Co-Authors: S B Haga, N M A Lapointe, Jivan MoaddebAbstract:Some have proposed the integration of pharmacogenetic (PGx) testing into Medication Therapy Management (MTM) to enable further refinement of treatments to reduce risk of adverse responses and improve efficacy. PGx testing involves the analysis of genetic variants associated with therapeutic or adverse response and may be useful in enhancing the ability to identify ineffective and/or harmful drugs or drug combinations. This “enhanced” MTM might also reduce patient concerns about side effects and increase confidence that the Medication is effective, addressing 2 key factors that impact patient adherence: concern and necessity. However, the feasibility and effectiveness of the integration of PGx testing into MTM in clinical practice has not yet been determined. In this commentary, we consider some of the challenges to the integration and delivery of PGx testing in MTM services.
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pilot study incorporation of pharmacogenetic testing in Medication Therapy Management services
Pharmacogenomics, 2014Co-Authors: S B Haga, Rachel Mills, Jivan Moaddeb, Nancy Allen M Lapointe, Mahesh J Patel, William E KrausAbstract:Aim: To describe the rationale and design of a pilot study evaluating the integration of pharmacogenetic (PGx) testing into pharmacist-delivered Medication Therapy Management (MTM). Study rationale: Clinical delivery approaches of PGx testing involving pharmacists may overcome barriers of limited physician knowledge about and experience with testing. Study design: We will assess the addition of PGx testing to MTM services for cardiology patients taking three or more Medications including simvastatin or clopidogrel. We will measure the impact of MTM plus PGx testing on drug/dose adjustment and clinical outcomes. Factors associated with delivery, such as time to prepare and conduct MTM and consult with physicians will be recorded. Additionally, patient interest and satisfaction will be measured. Anticipated results: We anticipate that PGx testing can be practically integrated into standard a MTM service, providing a viable delivery model for testing. Conclusion: Given the lack of evidence of an effective PGx delivery models, this study will provide preliminary evidence regarding a pharmacist-delivered approach.
William R Doucette - One of the best experts on this subject based on the ideXlab platform.
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variation in Medication Therapy Management delivery implications for health care policy
Author, 2018Co-Authors: Margie E. Snyder, Stephanie A Gernant, Heather A Jaynes, Wendy M Lantaff, Karen Suchanek Hudmon, William R DoucetteAbstract:BACKGROUND: Medication Therapy Management (MTM) program evaluations have revealed mixed outcomes, with some studies finding favorable outcomes and others finding no differences between patients who...
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Medication Therapy Management and complex patients with disability a randomized controlled trial
Annals of Pharmacotherapy, 2014Co-Authors: Elizabeth A Chrischilles, William R Doucette, Karen B Farris, Scott D Lindgren, Brian M Gryzlak, Linda M Rubenstein, Kelly Youland, Robert B WallaceAbstract:Background: Drug Therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities. Objective: To compare the effects of a modified Medication Therapy Management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations. Methods: Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice. Interventions: 8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative Medication Management (CMM) module. Primary outcome: mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in Medication regimens and self-reported ADEs. Analysis: general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes). Results: Participants had high symptom burden, low physical health, an...
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positioning and integrating Medication Therapy Management
Journal of The American Pharmacists Association, 2012Co-Authors: Jon C Schommer, William R Doucette, Kathleen A Johnson, Lourdes G PlanasAbstract:Abstract Objectives To summarize findings from Medication Therapy Management (MTM) “environmental scans” conducted from 2007 through 2010, interpret findings from the environmental scans using insights gained from the Future of MTM Roundtable convened in October 2010, and propose ideas for future positioning and integrating of MTM programs in the U.S. health care system. Methods Data for the environmental scans were collected from purposive samples of MTM pharmacist providers and MTM payers throughout the United States using self-administered online surveys in 2007, 2008, 2009, and 2010. Results Based on the findings, it appears that MTM is becoming more developed and that some aspects of MTM have become established within the organizations that are providing and paying for these programs. However, the findings also revealed that a need exists to better integrate MTM between organizations and patients serviced (business-to-consumer relationships), between partnering organizations (business-to-business relationships), and between collaborating practitioners (peer-to-peer relationships). Conclusion The findings suggest that a “channel of distribution” is emerging in which organizational relationships and cost efficiencies will be important considerations in the near term. We propose that applying (1) customer portfolio Management and (2) transaction cost economics would help improve positioning and integrating MTM into the U.S. health care system.
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retrospective financial analysis of Medication Therapy Management services from the pharmacy s perspective
Journal of The American Pharmacists Association, 2010Co-Authors: Randal P Mcdonough, Aaron A Harthan, Kelly E Mcleese, William R DoucetteAbstract:Abstract Objective To determine the net financial gain or loss for Medication Therapy Management (MTM) services provided to patients by an independent community pharmacy during 16 months of operation. Design Retrospective study. Setting Independent community pharmacy in Iowa City, IA, from September 1, 2006, to December 31, 2007. Patients Patients receiving MTM services during the specified period who had proper documentation of reimbursement for the services. Intervention MTM services were provided to the patient and documented by the pharmacist or student pharmacist. Main outcome measure Net financial gains or losses for providing MTM services. Sensitivity analyses included costs that might be incurred under various conditions of operation. Results 103 initial and 88 follow-up MTM visits were conducted during a 16-month time period. The total cost for these services to the pharmacy was $11,191.72. Total revenue from these services was $11,195.00; therefore, the pharmacy experienced a net financial gain of $3.28. Sensitivity analyses were conducted, revealing the net gain/loss to the pharmacy if a student pharmacist was used and the net gain/loss if the pharmacist needed extra training to provide the services. Using a student pharmacist resulted in a net gain of $6,308.48, while extra training for the pharmacist resulted in a net loss of $1,602.72. Conclusion The MTM service programs showed a positive financial gain after 16 months of operation, which should encourage pharmacists to incorporate these services into their practice.
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pharmacist provided Medication Therapy Management part 2 payer perspectives in 2007
Journal of The American Pharmacists Association, 2008Co-Authors: Jon C Schommer, Kathleen A Johnson, Lourdes G Planas, William R DoucetteAbstract:Abstract Objectives : To collect and describe payer perspectives regarding (1) implementation strategies used for providing Medication Therapy Management (MTM) services to patients/clients; (2) specific measures, if any, used to quantify the costs and benefits of MTM; (3) how the value of MTM services was tracked during 2007; and (4) barriers to offering MTM services to patients/clients. Design : Descriptive, nonexperimental, cross-sectional study. Setting : United States during 2007. Participants : Of the 1,898 payers who presumably received an e-mail invitation to participate in the survey, 132 (7%) responded. In addition to the online survey, 20 individuals who reported that they developed or used MTM for their organization participated in a telephone interview consisting of open-ended questions. Interventions : Self-administered online survey and telephone interview. Main outcome measures : Implementation and monitoring of MTM. Results : The results showed that 20% (n = 26) of the e-mail survey respondents offered MTM services to their members as described in the consensus definition of MTM. Payers for MTM services varied widely on how they implemented and monitored their organization's MTM programs. For 2008, MTM payer organizations plan to expand their use of face-to-face pharmacist-patient interaction. Conclusion : During 2008, plans may have greater opportunity to measure outcomes in a longitudinal fashion and make adjustments to MTM provision strategies. Some evidence for this was suggested in respondent comments to our survey, but future validation is needed before reaching a firm conclusion.
Margie E. Snyder - One of the best experts on this subject based on the ideXlab platform.
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patterns and predictors of older adult medicare part d beneficiaries receipt of Medication Therapy Management
Research in Social & Administrative Pharmacy, 2020Co-Authors: Antoinette B Coe, Margie E. Snyder, Karen B Farris, Alan J Zillich, Omolola A Adeoyeolatunde, Deborah L Pestka, Joel F FarleyAbstract:Abstract Background Medicare Part D Medication Therapy Management (MTM) includes an annual comprehensive Medication review (CMR) as a strategy to mitigate suboptimal Medication use in older adults. Objectives To describe the characteristics of Medicare beneficiaries who were eligible, offered, and received a CMR in 2013 and 2014 and identify potential disparities. Methods This nationally representative cross-sectional study used a 20% random sample of Medicare Part A, B, and D data linked with Part D MTM files. A total of 5,487,343 and 5,822,188 continuously enrolled beneficiaries were included in 2013 and 2014, respectively. CMR use was examined among a subset of 620,164 and 669,254 of these beneficiaries enrolled in the MTM program in 2013 and 2014. Main measures were MTM eligibility, CMR offer, and CMR receipt. The Andersen Behavioral Model of Health Services Use informed covariates selected. Results In 2013 and 2014, 505,658 (82%) and 649,201 (97%) MTM eligible beneficiaries were offered a CMR, respectively. Among those, CMR receipt increased from 81,089 (16%) in 2013 to 119,181 (18%) in 2014. The mean age of CMR recipients was 75 years (±7) and the majority were women, White, and without low-income status. In 2014, lower odds of CMR receipt were associated with increasing age (adjusted odds ratio (OR) = 0.99 (95% confidence interval (CI) = 0.994–0.995), male sex (OR = 0.93, 95% CI = 0.926–0.951), being any non-White race/ethnicity except Black, dual-Medicaid status (OR = 0.64, 95% CI = 0.626–0.650), having a hospitalization (OR = 0.87, 95% CI = 0.839–0.893) or emergency department visit (OR = 0.67, 95% CI = 0.658–0.686), and number of comorbidities (OR = 0.90, 95% CI = 0.896–0.905). Conclusions CMR offers and completion rates have increased, but disparities in CMR receipt by age, sex, race, and dual-Medicaid status were evident. Changes to MTM targeting criteria and CMR offer strategies may be warranted to address disparities.
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Medication Therapy Management: Current Challenges.
Integrated pharmacy research & practice, 2020Co-Authors: Stefanie P. Ferreri, Tamera D. Hughes, Margie E. SnyderAbstract:Medication Therapy Management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.
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Medication Therapy Management delivery by community pharmacists insights from a national sample of medicare part d beneficiaries
Publisher, 2019Co-Authors: Omolola A Adeoye, Joel F Farley, Karen B Farris, Alan J Zillich, Antoinette B Coe, Deborah L Pestka, Margie E. SnyderAbstract:Introduction The Medicare Part D Medication Therapy Management (MTM) program positions pharmacists to optimize beneficiaries' Medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types. Objectives To (1) characterize Medicare Part D MTM delivery by community pharmacists, (2) compare MTM delivery by community pharmacists to other pharmacists, and (3) generate hypotheses for future research. Methods A descriptive cross-sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen's Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers. Results Among beneficiaries sampled, community pharmacists provided comprehensive Medication reviews (CMRs) to 22% (n=26,337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face-to-face. Across pharmacist cohorts, median days to CMR offer of post-MTM program enrollment were within the 60-day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more Medication Therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; p<0.001), but resolved less MTPs (0.2 [0.7]; p<0.001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (p<0.001). Conclusion Community pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by non-community pharmacists. Future research should explore geographic/racial-ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.
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variation in Medication Therapy Management delivery implications for health care policy
Author, 2018Co-Authors: Margie E. Snyder, Stephanie A Gernant, Heather A Jaynes, Wendy M Lantaff, Karen Suchanek Hudmon, William R DoucetteAbstract:BACKGROUND: Medication Therapy Management (MTM) program evaluations have revealed mixed outcomes, with some studies finding favorable outcomes and others finding no differences between patients who...
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impact of passive and active promotional strategies on patient acceptance of Medication Therapy Management services
Author, 2015Co-Authors: Alison L Huet, Caitlin K Frail, Leslie M Lake, Margie E. SnyderAbstract:Abstract Objectives To assess the impact of passive and active promotional strategies on patient acceptance of Medication Therapy Management (MTM) services, and to identify reasons for patient acceptance or refusal. Methods Four promotional approaches were developed to offer MTM services to eligible patients, including letters and bag stuffers ("passive" approaches), and face-to-face offers and telephone calls ("active" approaches). Thirty pharmacies in a grocery store chain were randomized to one of the four approaches. Patient acceptance rates were compared among the four groups, and between active and passive approaches using hierarchical logistic regression techniques. Depending on their decision to accept or decline the service, patients were invited to take part in one of two brief telephone surveys. Results No significant differences were identified among the four promotional methods or between active and passive methods in the analyses. Patients' most frequent reasons for accepting MTM services were potential cost savings, review of how the Medications were working, the expert opinion of the pharmacist, and education about Medications. Patients' most frequent reasons for declining MTM services were that the participant already felt comfortable with their Medications and felt their pharmacist provides these services on a regular basis. Conclusion No significant difference was found among any of the four groups or between active or passive approaches. Further research is warranted to identify strategies for improving patient engagement in MTM services.
Paul J Perry - One of the best experts on this subject based on the ideXlab platform.
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analysis of pharmacist provided Medication Therapy Management mtm services in community pharmacies over 7 years
Journal of Managed Care Pharmacy, 2015Co-Authors: Mitchell J Barnett, Brand A Newland, Jessica Frank, Heidi J Wehring, Shannon Vonmuenster, Patty Kumbera, Tom Halterman, Paul J PerryAbstract:BACKGROUND: Although community pharmacists have historically been paid primarily for drug distribution and dispensing services, Medication Therapy Management (MTM) services evolved in the 1990s as a means for pharmacists and other providers to assist physicians and patients in managing clinical, service, and cost outcomes of drug Therapy. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) and the subsequent implementation of Medicare Part D in January 2006 for the more than 20 million Medicare beneficiaries enrolled in the Part D benefit formalized MTM services for a subset of high-cost patients. Although Medicare Part D has provided a new opportunity for defining the value of pharmacist-provided MTM services in the health care system, few publications exist which quantify changes in the provision of pharmacist-provided MTM services over time. OBJECTIVES: To (a) describe the changes over a 7-year period in the primary types of MTM services provided by community pharmacies that have contracted with drug plan sponsors through an MTM administrative services company, and (b) quantify potential MTM-related cost savings based on pharmacists’ self-assessments of the likely effects of their interventions on health care utilization.