Table 1.

Medication Therapy Management Program Components and Definitions

Component	Description	Timing
Medication therapy management	Pharmacists or advanced practitioners address potential medication-related problems with patients and physicians in 3 steps: medication reconciliation, medication review, and issue resolution
Medication reconciliation	Generate accurate and complete list of what medications a patient is taking, including prescription medications, over-the-counter medications, herbals, and supplements	Monthly
Medication review	Review of medication list by advanced practitioners to identify medication-related problems such as gaps or duplications in therapy, kidney dosing/frequency issues, and contraindications	After medication reconciliation; also target recently discharged patients, patients with adherence issues, and patients with multiple comorbid conditions
Issue resolution	Issues identified during the medication review are escalated to prescribers to resolve medication-related problems	As needed, based on identified potential medication-related problems
Deprescribing	The process of tapering, stopping, discontinuing, or withdrawing drugs, with the goal of managing polypharmacy and improving outcomes	Ongoing based on identified issues
Kidney-specific drug utilization review	Automated kidney clinical protocol performed runs on the patient’s medication list that flags potential medication-related problems that require resolution	Each time an updated medication list is produced