Discrepancies Identified with the Use of Prescription Claims and Diagnostic Billing Data Following a Comprehensive Medication Review

BACKGROUND: The University of Florida College of Pharmacy’s Medication Therapy Management Communication and Care Center (UF MTMCCC) provides medication therapy management (MTM) services to patients enrolled in a State of Florida Medicaid Waiver Program: Medicaid for the Aged and Disabled. To provide these services, UF MTMCCC was given access to patients’ prescription claims data and diagnostic billing data in the form of ICD-9 codes. Prior to calling a patient, a precomprehensive medication review (CMR) work-up was performed to identify potential medication-related problems (MRPs) and/or health-related problems (HRPs). Based on information provided by the patient in relation to comorbidities, medications, and medical history during the interactive telephone conversation, problems were either confirmed or eliminated. All of the reported information was also assessed to identify any new MRPs or HRPs. Accordingly, telephonic MTM services have the potential to bridge the gap between pharmacy claims data and p...