Comprehensive Medication Reviews (CMR)

Comprehensive Medication Reviews (CMRs) are a billable and reimbursable service. Primary Care Providers (PCPs) are encouraged to perform CMRs for polypharmacy patients, or any patient that requests one.

What is a Comprehensive Medication Review (CMR)?

A Comprehensive Medication Review (CMR) is a detailed evaluation of medications including prescription drugs, over-the-counter medications, herbal supplements, and vitamins to identify and resolve potential medication-related problems . By administrating CMRs, providers and pharmacists can assess for adherence and provide counseling and education to patients. 

What is polypharmacy?

Polypharmacy is the simultaneous use of multiple drugs by a single patient to treat one or more conditions. New Hampshire DHHS defines polypharmacy members by the following criteria:

  • For adults:  dispensed five (5) or more maintenance drugs over a rolling sixty (60) day period
  • For children: dispensed four (4) or more maintenance drugs based over a rolling sixty (60) day period, each drug must be filled for at least 90 days in duration with up to one 15 day gap between fills

Resources for completing CMRs

Providers can use the information below to successfully complete CMRs.

Providers can access their CMR eligible patient lists via the Office Management: Provider Reporting Tool section of the WellSense provider portal.  CMR lists are accessible by any staff member with access to the provider portal.

CMR lists include member demographics such as, name, Medicaid and WellSense ID numbers, date of birth, provider name, etc., and should be used to assist in outreaching patients to schedule a CMR appointment. 

On average, a CMR takes about 30 minutes to complete and can be completed in person, telephonically, or virtually. CMRs can be completed with the patient or an authorized representative/guardian. Once completed, CMRs should be included in a member’s medical record.

A successful CMR should always:

  • Identify adherence issues, detect adverse drug reactions (ADRs), educate patients, and review potential drug interactions.
  • Improve patients’ knowledge of their prescriptions, over-the-counter medications, herbal therapies and dietary supplements.
  • Identify and address any barriers to care a patient may face with their current medication regimen.
  • Empower patients to self-manage their medications and their health conditions.
  • Consist of follow-up via automated calling systems, letters, phone calls, secure email, and texts.
  • Provide the patient with a copy of the CMR results, which should include an action plan and education points.

CMRs are a great time for the patient to start a conversation about their medication. It can help the patient:

  • Understand their medications
  • Identify medication side effects and how to manage them, and
  • Identify safe medication alternatives or determine if medications should be stopped

Best practices for completing a CMR:

  • Remind and encourage patients to bring their full medication list (RX, OTCs, herbals, etc.)
  • Ask open ended questions to explore understanding
  • Practice reflective listening
  • Encourage questions to empower the patient & personalize the discussion
  • Always follow-up 

Providers are expected to follow-up with patients post-CMR completion. Follow-up instructions should be provided at the time of CMR completion, or within 7 business days and should include (but are not limited to): a summary of the discussion, an action plan, and any follow-up steps a member should take.

Completed CMRs are a billable and reimbursable service through claims submission. CMR claims should follow typical claims submission processes and timeframes.

For step-by-step guidance on how to submit a claim, visit our provider module: How to submit a claim.  For information on rates, or the complete The Primary Care and Prevention Focused Model of Care Fee Schedule, (as of 9/1/2024), visit New Hampshire MMIS Health Enterprise Portal.