Optimizing MTM Services for Patients With Cardiometabolic Conditions: A Practical Guide for Pharmacists

Cardiometabolic diseases, including diabetes, dyslipidemia, and cardiovascular disease, remain leading drivers of morbidity, mortality, and health care costs in the United States.¹ These conditions are chronic, multifactorial, and highly medication dependent, making them ideal targets for pharmacist-led Medication Therapy Management (MTM) services.

Since its formal introduction through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, MTM has evolved into an integral part of patient-centered care.² For community pharmacists, MTM represents more than just a medication review. It is a structured, comprehensive encounter that allows pharmacists to assess therapy, identify gaps in care, and intervene in ways that directly improve clinical outcomes.³ For patients with cardiometabolic disease, this includes barriers to adherence, minimizing adverse effects, optimizing therapy, and improving overall understanding of their condition and drug therapy.

Identifying the right patients is the first step in optimizing MTM services.⁴ Individuals with uncontrolled cardiometabolic conditions, multiple comorbidities, or recent transitions of care offer the greatest opportunity for interventions. Reviewing claims data, medication fill histories, and electronic health record flags can help pharmacists identify gaps in adherence, therapeutic duplication, or suboptimal therapy. Patients recently discharged from the hospital are another high-yield group, as they are particularly vulnerable to medication discrepancies and adverse events. By proactively targeting these populations, pharmacists can prevent adverse events, improve medication continuity, and reduce readmissions.⁵

Pharmacists should incorporate available tools and services to provide a more comprehensive evaluation. This may include point-of-care testing such as lipid panels or hemoglobin A_1C, blood pressure assessment, and continuous glucose monitor data interpretation. Equally important is addressing medication adherence, adverse effects, affordability, appropriateness of therapy, and health literacy.³ Many patients with cardiometabolic disease face cost-related barriers, and identifying lower-cost alternatives or assistance programs can significantly improve outcomes. Lifestyle counseling should also be integrated into every encounter. Even brief, targeted interventions focused on nutrition, physical activity, and smoking cessation can reinforce pharmacologic therapy and support long-term disease control.

Each MTM encounter should systematically address therapeutic goals, medication appropriateness, safety, adherence, and gaps in care.⁶ Embedding these elements into workflow ensures that key interventions are not missed even in busy community pharmacy settings.

Pharmacy technicians can play a valuable role in supporting MTM delivery. Trained technicians can assist with identifying adherence gaps, preparing documentation, reconciling medication lists, and flagging potential drug interactions.⁷ Delegating these tasks allows pharmacists to focus on clinical decision-making and patient engagement, improving both workflow efficiency and high-quality patient care.

Pharmacists play a central role in optimizing pharmacotherapy for cardiometabolic conditions. Interventions may include initiating or intensifying statin therapy, optimizing antihypertensive regimens, adjusting diabetes medications, ensuring appropriate renal dosing, and identifying opportunities for deprescribing.³ Strong communication with prescribers is essential to ensure timely implementation of recommendations.⁸ In settings with collaborative practice agreements, pharmacists can directly initiate or modify therapy, improving or eliminating delays in care.

Tracking outcomes is important for both patient care and program sustainability.⁵ Key clinical metrics such as blood pressure, hemoglobin A_1C, and lipid levels should be monitored over time to assess progress toward therapeutic goals. In addition, tracking hospitalizations, emergency department visits, and total health care use can help demonstrate the broader impact of MTM services.

Evidence consistently shows that pharmacist-led MTM improves clinical outcomes and can reduce total health care costs by preventing complications and optimizing therapy.^3,5,9 Demonstrating value is essential, as pharmacists continue to advocate and expand roles and reimbursement opportunities. MTM services are covered under Medicare Part D, though eligibility criteria and payment structures vary by plan and often limit reach.¹⁰ Expanding reimbursement models and integrating pharmacists into value-based frameworks remain key opportunities to further scale MTM services in the community setting.

As the burden of cardiometabolic disease continues to rise, pharmacists are uniquely positioned to close gaps in care. By strategically identifying patients, standardizing workflows, leveraging the pharmacy team, and focusing on measurable outcomes, pharmacists can maximize the impact of MTM services. Ultimately, optimizing MTM is not just about improving metrics. It is about identifying risk earlier, intervening more effectively, and ultimately changing the trajectory of cardiometabolic disease for the patients we serve.

REFERENCES

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2. Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub L No. 108-173, 117 Stat 2066 (2003). Accessed April 27, 2026. https://www.congress.gov/bill/108th-congress/house-bill/1

3. Marupuru S, Roether A, Guimond AJ, Stanley C, Pesqueira T, Axon DR. A systematic review of clinical outcomes from pharmacist provided Medication Therapy Management (MTM) among patients with diabetes, hypertension, or dyslipidemia. Healthcare (Basel). 2022;10(7):1207. doi:10.3390/healthcare10071207

4. Isetts BJ, Schondelmeyer SW, Artz MB, et al. Clinical and economic outcomes of Medication Therapy Management services: the Minnesota experience. J Am Pharm Assoc (2003). 2008;48(2):203-214. doi:10.1331/JAPhA.2008.07108

5. Deng ZJ, Gui L, Chen J, Peng SS, Ding YF, Wei AH. Clinical, economic and humanistic outcomes of Medication Therapy Management services: a systematic review and meta-analysis. Front Pharmacol. 2023;14:1143444. doi:10.3389/fphar.2023.1143444

6. Cheeley MK, Kirkpatrick CF, Brown EE, et al. Multidisciplinary teams in clinical lipidology and cardiometabolic care: a National Lipid Association Expert Clinical Review. J Clin Lipidol. 2025;19(4):737-747. doi:10.1016/j.jacl.2025.05.002

7. Gernant SA, Nguyen MO, Siddiqui S, Schneller M. Use of pharmacy technicians in elements of Medication Therapy Management delivery: a systematic review. Res Social Adm Pharm. 2018;14(10):883-890. doi:10.1016/j.sapharm.2017.11.012

8. Hirsch JD, Steers N, Adler DS, et al. Primary care-based, pharmacist-physician collaborative medication-therapy management of hypertension: a randomized, pragmatic trial. Clin Ther. 2014;36(9):1244-1254. doi:10.1016/j.clinthera.2014.06.030

9. Alshehri AA, Jalal Z, Cheema E, Haque MS, Jenkins D, Yahyouche A. Impact of the pharmacist-led intervention on the control of medical cardiovascular risk factors for the primary prevention of cardiovascular disease in general practice: a systematic review and meta-analysis of randomised controlled trials. Br J Clin Pharmacol. 2020;86(1):29-38. doi:10.1111/bcp.14164

10. Medication Therapy Management. Centers for Medicare & Medicaid Services. March 2, 2026. Accessed April 27, 2026. https://www.cms.gov/medicare/coverage/prescription-drug-coverage-contracting/medication-therapy-management