Medication Therapy Management Visits Research Articles

Optimizing Longitudinal Tobacco Cessation Treatment in Lung Cancer Screening

Nearly half of the 14.8 million US adults eligible for lung cancer screening (LCS) smoke cigarettes. The optimal smoking cessation program components for the LCS setting are unclear. To assess the effect of adding a referral to prescription medication therapy management (MTM) to the tobacco longitudinal care (TLC) program among patients eligible for LCS who smoke and do not respond to early tobacco treatment and to assess the effect of decreasing the intensity of TLC among participants who do respond to early treatment. This randomized clinical trial included patients who currently smoked cigarettes daily and were eligible for LCS. Recruitment took place at primary care centers and LCS programs at 3 large health systems in the US and began in October 2016, and 18-month follow-up was completed April 2021. (1) TLC comprising intensive telephone coaching and combination nicotine replacement therapy for 1 year with at least monthly contact; (2) TLC with MTM, MTM offered pharmacist-referral for prescription medications; and (3) Quarterly TLC, intensity of TLC was decreased to quarterly contact. Intervention assignments were based on early response to tobacco treatment (abstinence) that was assessed either 4 weeks or 8 weeks after treatment initiation. Self-reported, 6-month prolonged abstinence at 18-month. Of 636 participants, 228 (35.9%) were female, 564 (89.4%) were White individuals, and the median (IQR) age was 64.3 (59.6-68.8) years. Four weeks or 8 weeks after treatment initiation, 510 participants (80.2%) continued to smoke (ie, early treatment nonresponders) and 126 participants (19.8%) had quit (ie, early treatment responders). The 18 month follow-up survey response rate was 83.2% (529 of 636). Across TLC groups at 18 months follow-up, the overall 6-month prolonged abstinence rate was 24.4% (129 of 529). Among the 416 early treatment nonresponders, 6-month prolonged abstinence for TLC with MTM vs TLC was 17.8% vs 16.4% (adjusted odds ratio [aOR] 1.13; 95% CI, 0.67-1.89). In TLC with MTM, 98 of 254 participants (39%) completed at least 1 MTM visit. Among 113 early treatment responders, 6-month prolonged abstinence for Quarterly TLC vs TLC was 24 of 55 (43.6%) vs 34 of 58 (58.6%) (aOR, 0.54; 95% CI, 0.25-1.17). In this randomized clinical trial, adding referral to MTM with TLC for participants who did not respond to early treatment did not improve smoking abstinence. Stepping down to Quarterly TLC among early treatment responders is not recommended. Integrating longitudinal tobacco cessation care with LCS is feasible and associated with clinically meaningful quit rates. ClinicalTrials.gov Identifier: NCT02597491.

Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System.

Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006. To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system. Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 primary care clinics. Patients eligible for MTM services were aged 21 years or older and either paid for MTM out of pocket or met their health care payer's criteria for MTM reimbursement; the criteria varied for Medicaid, Medicare, and commercially insured enrollees. All MTM was delivered face to face. Health data extracted from the electronic therapeutic record by the present study's investigators included patient demographics, medication list, medical conditions, drug therapy problems identified and addressed, change in clinical status, and pharmacist-estimated cost savings. The clinical status assessment was a comparison of the first and most recent MTM visit to measure whether the patient achieved the goals of therapy for each medical condition (e.g., the blood pressure of a patient with diabetes and hypertension will be less than 130/80 millimeters mercury [mmHg] in 1 month; the patient with allergic rhinitis will be relieved of his complaints of nasal congestion, runny nose, and eye itching within 5 days). Goals were set according to evidence-based literature and patient-specific targets determined cooperatively by pharmacists, patients, and physicians. Cost-savings calculations represented MTM pharmacists' estimates of medical services (e.g., office visits, laboratory services, urgent care visits, emergency room visits) and lost work time avoided by the intervention. All short-term (3-month) estimated health care savings that resulted from addressing drug therapy problems were analyzed. The expenses of these avoided services were calculated using the health system's contracted rates for services provided in the last quarter of 2008. The return on investment (ROI) was calculated by dividing the pharmacist-estimated savings by the cost of MTM services in 2008 (number of MTM encounters times the average cost of an MTM visit). The humanistic impact of MTM services was assessed using the results from the second patient satisfaction survey administered in 2008 (new patients seen from January through December 2008) for the health system's MTM program. A total of 9,068 patient records were in the documentation system as of September 30, 2008. During the 10-year period, there were 33,706 documented encounters (mean 3.7 encounters per patient). Of 38,631 drug therapy problems identified and addressed by MTM pharmacists, the most frequent were a need for additional drug therapy (n = 10,870, 28.1%) and subtherapeutic dosage (n = 10,100, 26.1%). In the clinical status assessment of the 12,851 medical conditions in 4,849 patients who were not at goal when they enrolled in the program, 7,068 conditions (55.0%) improved, 2,956 (23.0%) were unchanged, and 2,827 (22.0%) worsened during the course of MTM services. Pharmacist-estimated cost savings to the health system over the 10-year period were $2,913,850 ($86 per encounter) and the total cost of MTM was $2,258,302 ($67 per encounter), for an estimated ROI of $1.29 per $1 in MTM administrative costs. In the patient satisfaction survey, 95.3% of respondents agreed or strongly agreed that their overall health and well-being had improved because of MTM. Pharmacist estimates of the impact of an MTM program in a large integrated health care system suggest that the program was associated with improved clinical outcomes and cost savings. Patient satisfaction with the program was high. There was no external funding for this manuscript. The 3 authors are employees of Fairview Pharmacy Services. Ramalho de Oliveira had primary responsibility for the concept and design, writing, and revision of the manuscript, with the assistance of Brummel and Miller. Ramalho de Oliveira performed the data collection, and all 3 authors shared equally in data interpretation.

The effect of an interprofessional pain service on nonmalignant pain control.

The primary objective of this project was to evaluate an existing interprofessional, nonmalignant pain service by measuring the difference in patient pain scores (numeric rating scale-11) before and after a pharmacist-led pain education class and medication therapy management (MTM) visit. Secondary objectives included determining the percentage of pharmacist recommendations approved, patient satisfaction, and difference in immediate release (IR) and extended release (ER) opioid use before and after enrollment. Baseline data were obtained from a retrospective chart review. Enrolled patients attended an educational pain class with the pharmacist. At the MTM visit with the pharmacist 3-14 days after the initial education class, the patient's pain score was assessed along with his/her medication use, and a care plan was developed and forwarded to the referring provider for implementation. Three months after the pain class and participation in the MTM visit, patients were contacted via telephone to complete a survey. The survey questions assessed patient satisfaction with the pain education program, their current pain score, and their knowledge of information covered during the pain class. Patients reported an average preenrollment pain score of 8.3/10 (n = 39) and a post-survey pain score of 5.6/10 (n = 39). The IR opioid use averaged 19.7 morphine equivalent daily dose (MEDD) at enrollment and decreased by 40% to 11.8 MEDD. The provider approval rate of the pharmacist-recommended interventions ranged from 80% to 92%, depending on the predesignated disease state category. An interprofessional, nonmalignant-pain service including a pharmacist-led class resulted in a decrease in average pain scores and MEDD in an underserved population.

Drug Therapy Problem Identification and Resolution by Clinical Pharmacists in a Family Medicine Residency Clinic.

There are limited data to evaluate the impact of ambulatory clinical pharmacist recommendations on family medicine resident prescribing and monitoring of medications. The purpose of this study is to begin to gain insight in this area by answering the research question, "How many ambulatory clinical pharmacist recommendations for drug therapy problem (DTP) resolution are implemented on the day of a medication therapy management (MTM) visit in an outpatient family medicine residency clinic?" This is a retrospective chart review of face-to-face MTM encounters conducted by ambulatory clinical pharmacists (including pharmacist residents) from August 1, 2012 to June 30, 2015 at a family medicine residency clinic. Descriptive statistics were conducted to both quantify the number of DTPs identified and resolved on the day of the MTM visit as well as categorize the DTPs. Based on the 728 MTM encounters analyzed, patients were an average of 53.6 years old and took 11.9 medications to treat 5.7 medical conditions. A total of 3057 DTPs were identified in the 728 encounters, of which 1303 were resolved the same day as the MTM visit. This resulted in an average of 4.2 DTPs identified and 2.0 resolved per visit per patient. The most common DTP category identified in this study was the need for additional drug therapy (41.6%). Approximately half of the ambulatory clinical pharmacist's DTP resolution recommendations were implemented the same day they were identified, which highlights the strength of team-based patient care and interprofessional collaboration in a residency teaching clinic.

Plan pays pharmacists for performance

Pharmacists will be paid for performance in a medication therapy management (MTM) diabetes program under a contract that starts June 1. The contract was negotiated between Minnesota’s State Employee Group Insurance Plan (SEGIP) and a statewide MTM provider network run by the University of Minnesota College of Pharmacy. The pioneering MTM network has provided the MTM benefi t for University of Minnesota employees, covering about 39,000 people, for several years. Now the network is expanding its reach. SEGIP estimates that 6,000 state employees are diagnosed with diabetes. The network—currently known as UPlan

Impact of Medication Therapy Management on Underserved, Primarily Hispanic Patients with Diabetes

Diabetes-related complications are more pronounced in Hispanic patients versus patients of other ethnicities. It is documented that medication therapy management (MTM) can improve diabetes outcomes; however, data regarding Hispanic patients are limited. To evaluate the impact of MTM on hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in underserved, primarily Hispanic patients who use a safety-net clinic as their medical home. A retrospective, observational study of uninsured, primarily Hispanic patients with diabetes who received MTM from October 2009 through March 2011. Patients were stratified into 2 cohorts: A1C less than 9% and A1C greater than or equal to 9%. Patients were also stratified by frequency of MTM visits and insulin use, regardless of A1C. A chart review was conducted to evaluate diabetes-related outcomes pre- and postimplementation of MTM. The primary study outcome was reduction of A1C. Secondary outcomes included reduction of BP and LDL-C and reduction of A1C based on MTM visit frequency or insulin use. Sixty-four patients with at least 1 MTM visit and pre- and postimplementation A1C data were included. In the cohort with A1C greater than or equal to 9%, mean (SD) A1C values decreased from 10.9% (1.4%) to 8.8% (1.5%) versus the cohort with A1C less than 9%, whose A1C changed minimally, from 7.2% (0.9%) to 7.4% (1.4%). Regardless of their A1C, patients who were using insulin at baseline had a change in A1C of -0.8% (1.5%) versus -0.1% (1.6%) in those who were not using insulin at baseline (p = 0.04); patients who participated in multiple MTM visits had a significant reduction in A1C, from 9% to 8.3% (95% CI -1.26 to -0.03; p = 0.02) compared with patients participating in only 1 MTM visit. Pharmacist-provided MTM can significantly improve diabetes control in uninsured, primarily Hispanic patients with poorly controlled diabetes and in those who are using insulin. Multiple MTM visits also yielded significant A1C reductions.

Patient Characteristics Predicting the Frequency of Medication Therapy Management Visits for Patients With Diabetes

BackgroundPatient characteristics associated with a higher exposure to medication therapy management (MTM) and the relationship between frequency of MTM visits and meeting clinically defined goals of therapy have not been documented. ObjectiveThe goal of this study was to evaluate factors predicting frequency of MTM visits for patients with diabetes and the impact of these visits on diabetes clinical outcomes. MethodsAll patients with diabetes participating in a 2007 MTM demonstration project (N = 121) were included in the analysis. A negative binomial regression controlling for age, sex, presence of diabetes complications, taking insulin, Charlson score Index, and hypertension and cholesterol medication regimen composition was used to assess predictors of the number of MTM visits. Optimal diabetes management differences between the 2 groups defined according to median number of MTM visits (low frequency, ≤4; high frequency, >4) was compared by using Wilcoxon Mann-Whitney and χ2 tests. ResultsHaving diabetes complications (relative risk = 2.83 [95% CI, 1.3–6.17]; P = 0.0088) and taking insulin (relative risk = 1.43 [95% CI, 1.12–1.83]; P = 0.0038) were associated with a higher number of MTM visits. At baseline, the high-frequency group had a significantly higher proportion of patients with insulin therapy (P < 0.01), higher proportion with diabetes complications (P = 0.07), and higher mean Charlson score (P = 0.08). The rate of optimal diabetes care was significantly lower in the high-frequency group before MTM (P = 0.02) but not statistically different from the low-frequency group during and 1 year after the demonstration project. ConclusionsPatients with diabetes complications and using regimens that include insulin received more frequent MTM visits. MTM services delivered to a diabetes population with more complex disease or taking insulin have a positive impact on optimal diabetes care.

Development and Initial Assessment of the Medication User Self-Evaluation (MUSE) Tool

BackgroundUsing patient-reported data to supplement claims-based indicators may be helpful in identifying Medicare beneficiaries likely to benefit from medication therapy management (MTM) services. ObjectiveOur objective was to develop and initially assess a patient medication user self-evaluation (MUSE) tool to identify Medicare Part D beneficiaries who would benefit from a comprehensive medication review. MethodsA random sample of 225 patient medication profiles was created from a survey of Medicare beneficiaries; the survey also included demographic characteristics, responses to adherence questions, and reported symptoms. Three clinical pharmacists used the patient profiles to make judgments regarding the likelihood (low, moderate, or high) that each patient would benefit from an MTM visit in the next 3 months. A total of 150 cases were used for model calibration, and 75 were used for validation. Ordinal logistic regression models were fit to predict the likelihood of benefit from an MTM visit by using different combinations of potential MUSE items. Final model selection was based on the Akaike information criterion and the percent agreement between model prediction and expert judgments in the validation data. Measures considered for inclusion in the MUSE tool were related to medication use, medical conditions, and health care utilization. ResultsThe final MUSE items incorporated number of medications, number of physicians, number of pharmacies, number of hospitalizations in the past 6 months, having forgotten to take medications, cost-related problems, and number of medical conditions. ConclusionThe 7-item MUSE tool could be used in targeting MTM services, such as comprehensive medication reviews, among Medicare beneficiaries.

Development of the Drug Adherence Work-up (DRAW) tool

ObjectiveTo develop and conduct an initial field test of the Drug Adherence Work-up (DRAW) tool, which was developed to guide pharmacists when addressing nonadherence during medication therapy management (MTM) visits. MethodsThe field test was a prospective cohort study, in which seven trained pharmacists used DRAW to evaluate patients by asking about possible reasons for nonadherence during an MTM visit. Pharmacists were notified of potentially nonadherent patients identified through drug claims data analyzed by Outcomes Pharmaceutical Health Care. The pharmacists reported on use of DRAW in an MTM claim and provided opinions about DRAW via an online survey. ResultsAccording to the online survey, pharmacists reported that DRAW helped them to improve the focus of their MTM services and address more adherence problems than their usual approach. They thought the tool was easy to use and well organized. Some commented that DRAW could be a useful tool for teaching pharmacists. The most common reasons reported for nonadherence were the presence of adverse effects (59.1%) or forgetting to take the medication (54.5%). More than three-fourths of patients (77.3%) indicated more than one reason for nonadherence. ConclusionA brief, comprehensive tool to evaluate medication nonadherence, such as DRAW, may help pharmacists address various reasons for medication nonadherence. Often nonadherence is multifaceted, which makes an inclusive tool like DRAW a useful approach; however further research is needed.

Challenges to implementation of MTM services

Challenges to implementation of MTM services

Evaluation of pharmacist-provided medication therapy management services in an oncology ambulatory setting

To determine the effect of formal medication therapy management (MTM) services on pharmacist workload, as well as to describe the population receiving MTM, describe the services provided, and determine the reimbursement rate for billed MTM services. MTM Current Procedural Terminology (CPT) code claims, electronic medical records, and pharmacist MTM logs. A retrospective review of all MTM charges from January 1, 2010, to March 31, 2010, was performed. Data collected included location of the MTM visit, age, gender, insurance, primary malignancy, comorbidities, home medications, time to complete and document the MTM visit, and rate of reimbursement. In the 3-month period, 239 MTM visits were completed. It took pharmacists a median of 20 minutes (range 15-127) of face-to-face time and 18 minutes (5-90) for documentation per visit. To date, no claims for MTM have been rejected, and reimbursement rates range from 47% to 79% depending on the insurance provider. MTM in the ambulatory clinic is feasible despite the increase in pharmacist workload from documenting and billing. The increased visibility of clinical pharmacy services justifies the extra time required for formal MTM.

Medication therapy management: 10 years of experience in a large integrated health care system.

Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006. To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system. Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 primary care clinics. Patients eligible for MTM services were aged 21 years or older and either paid for MTM out of pocket or met their health care payer's criteria for MTM reimbursement; the criteria varied for Medicaid, Medicare, and commercially insured enrollees. All MTM was delivered face to face. Health data extracted from the electronic therapeutic record by the present study's investigators included patient demographics, medication list, medical conditions, drug therapy problems identified and addressed, change in clinical status, and pharmacist-estimated cost savings. The clinical status assessment was a comparison of the first and most recent MTM visit to measure whether the patient achieved the goals of therapy for each medical condition (e.g., the blood pressure of a patient with diabetes and hypertension will be less than 130/80 millimeters mercury [mmHg] in 1 month; the patient with allergic rhinitis will be relieved of his complaints of nasal congestion, runny nose, and eye itching within 5 days). Goals were set according to evidence-based literature and patient-specific targets determined cooperatively by pharmacists, patients, and physicians. Cost-savings calculations represented MTM pharmacists' estimates of medical services (e.g., office visits, laboratory services, urgent care visits, emergency room visits) and lost work time avoided by the intervention. All short-term (3-month) estimated health care savings that resulted from addressing drug therapy problems were analyzed. The expenses of these avoided services were calculated using the health system's contracted rates for services provided in the last quarter of 2008. The return on investment (ROI) was calculated by dividing the pharmacist-estimated savings by the cost of MTM services in 2008 (number of MTM encounters times the average cost of an MTM visit). The humanistic impact of MTM services was assessed using the results from the second patient satisfaction survey administered in 2008 (new patients seen from January through December 2008) for the health system's MTM program. A total of 9,068 patient records were in the documentation system as of September 30, 2008. During the 10-year period, there were 33,706 documented encounters (mean 3.7 encounters per patient). Of 38,631 drug therapy problems identified and addressed by MTM pharmacists, the most frequent were a need for additional drug therapy (n = 10,870, 28.1%) and subtherapeutic dosage (n = 10,100, 26.1%). In the clinical status assessment of the 12,851 medical conditions in 4,849 patients who were not at goal when they enrolled in the program, 7,068 conditions (55.0%) improved, 2,956 (23.0%) were unchanged, and 2,827 (22.0%) worsened during the course of MTM services. Pharmacist-estimated cost savings to the health system over the 10-year period were $2,913,850 ($86 per encounter) and the total cost of MTM was $2,258,302 ($67 per encounter), for an estimated ROI of $1.29 per $1 in MTM administrative costs. In the patient satisfaction survey, 95.3% of respondents agreed or strongly agreed that their overall health and wellbeing had improved because of MTM. Pharmacist estimates of the impact of an MTM program in a large integrated health care system suggest that the program was associated with improved clinical outcomes and cost savings. Patient satisfaction with the program was high.

Retrospective financial analysis of medication therapy management services from the pharmacy's perspective

ObjectiveTo 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. DesignRetrospective study. SettingIndependent community pharmacy in Iowa City, IA, from September 1, 2006, to December 31, 2007. PatientsPatients receiving MTM services during the specified period who had proper documentation of reimbursement for the services. InterventionMTM services were provided to the patient and documented by the pharmacist or student pharmacist. Main outcome measureNet financial gains or losses for providing MTM services. Sensitivity analyses included costs that might be incurred under various conditions of operation. Results103 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. ConclusionThe MTM service programs showed a positive financial gain after 16 months of operation, which should encourage pharmacists to incorporate these services into their practice.

Generating demand for pharmacist-provided medication therapy management: Identifying patient-preferred marketing strategies

ObjectiveTo identify effective strategies for marketing pharmacist-provided medication therapy management (MTM) services to patients in a self-insured employer setting. DesignQualitative study. SettingUniversity of Pittsburgh during March through May 2008. Participants26 university employees taking at least one chronic medication. InterventionThree focus group sessions were conducted using a semistructured topic guide to facilitate the discussion. Main outcome measuresEmployees’ perceived medication-related needs, perceived benefits of pharmacist-provided MTM, potential barriers for employee participation in MTM, and effective strategies for marketing MTM. ResultsParticipants reported concerns with timing of doses, medication costs, access, and ensuring adherence. Participants generally felt positively toward pharmacists; however, the level of reported patient contact with pharmacists varied among participants. Some participants questioned pharmacists’ education and qualifications for this enhanced role in patient care. Perceived benefits of MTM noted by participants included the opportunity to obtain personalized information about their medications and the potential for improved communication among their health providers. Barriers to patient participation were out-of-pocket costs and lack of time for MTM visits. Participants suggested use of alternative words to describe MTM and marketing approaches that involve personal contact. ConclusionPharmacists should emphasize parts of MTM that patients feel are most beneficial (i.e., provision of a personal medication record) and use patient-friendly language to describe MTM when marketing their practice. Patients will need greater exposure to the concept of MTM and the pharmacists’ role in order to correctly describe and assign value to this type of pharmacist patient care practice.

Economic Impact of a Pharmacy Resident in an Assisted Living Facility—Based Medication Therapy Management Program

Pharmacists now have the opportunity to be reimbursed for providing medication therapy management (MTM) services. With 5% of the elderly population living in senior housing such as assisted living facilities, MTM programs need to be evaluated in this setting. To evaluate the economic impact of a postgraduate year 1 (PGY1) pharmacy practice resident's interventions while performing MTM in an assisted living facility. We conducted a prospective, evaluative study at an assisted living facility over 184 days. Patients included in the study were aged 57-100 years. MTM visits were performed by the PGY1 resident, based on the American Pharmacists Association consensus definition of the model of MTM services. The pharmacy resident prospectively collected data, including interventions made and patient demographics. Drug therapy recommendations were categorized and assessed for cost savings and acceptance by a primary care provider. Fifty-three patients were enrolled in the study (mean age 85.3 y). Patients were taking an average of 12 medications (prescription and nonprescription). The pharmacy resident made 125 recommendations to primary care providers; 72 of those were addressed and 90.3% of addressed recommendations were accepted. The largest category to elicit drug therapy recommendations was dose appropriateness. Of the 72 addressed recommendations, 17 (23.6%) resulted in direct cost savings totaling $3774. Costs that accrued as a result of drug therapy recommendations totaled $693. The resultant net cost-benefit was $1550, with a benefit-to-cost ratio of 1.7 and a return on investment of 70%. Our study demonstrates the positive value that a PGY1 pharmacy resident has on an assisted living-based MTM program, with respect to a positive drug-related cost-benefit and drug therapy recommendation acceptance.