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MT

Medication Therapy Review

🔵 Stable🕐 updated 2026-08-21 🔷 SkillSpec L3 pm-pharmacy

Structure a pharmacist's medication therapy review so it finds the problems worth escalating and documents them in a form a prescriber will act on. Use when asked to conduct a medication review, run an MTM or MUR, deprescribing review, or polypharmacy assessment, or to prepare a review for a patient on many medicines. Produces the medication list reconciled, the drug-therapy-problem list classified and prioritised, the patient-goal alignment, the prescriber recommendations with rationale, and the follow-up plan. A documentation and reasoning framework for a licensed pharmacist; it makes no clinical determination and recommends no specific drug or dose.

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🗣 Say this to your agent

“Structure a medication review for a patient on eleven medicines”“Help me write up an MTM for the prescriber”“Run a polypharmacy assessment”“How do I document a deprescribing recommendation?”“Prepare a medication use review for this patient”

What to give it

The medication list — prescribed, OTC, herbal and supplements, with doses and start dates
What the patient actually takes — including doses skipped, halved, or stopped, and why
The clinical context — active conditions, relevant lab values, renal and hepatic function, allergies, recent hospitalisations
The patient's goals and constraints — cost, swallowing difficulty, dosing burden, side effects they will not tolerate
Who prescribes what — multiple prescribers are where duplication and gaps hide

✅ The bar it holds itself to

Every skill in this library self-verifies — these are this skill's own quality checks, straight from its definition.

The list was reconciled against what the patient reports taking, not just the record
Discontinued and self-adjusted medicines were actively asked about
Every problem is classified into a named type
Prioritisation is by potential harm, not by how easy the fix is
Each recommendation states finding, rationale and one specific proposed action
The patient's own goals are recorded and conflicts named
Nothing asserts a clinical determination reserved to the prescriber

⚠️ What it refuses to do

**Reviewing the record instead of the patient.** The gap between the two is the whole finding.
**Listing without classifying.** An unclassified list is a summary, not a review.
**Leading with the easy wins.** A prescriber who reads three trivial items first stops reading.
**Recommendations without rationale.** 'Stop amlodipine' with no reason will be ignored, correctly.
**Ignoring what the patient wants.** A regimen the patient will not take is not a better regimen.

Install

npx pm-claude-skills add --agent claude   # or codex · cursor · gemini · hermes
# or one-line MCP (every skill, any client):
claude mcp add pm-skills -- npx -y pm-claude-skills-mcp

Related skills

🔌 Embed this skill

Drop this on your blog, docs, or site — it renders a "Run this skill" card:

<div data-pm-skill="medication-therapy-review"></div>
<script src="https://mohitagw15856.github.io/pm-claude-skills/embed.js" async></script>

💬 Discussion

Medication Therapy Review is one of 1153 open-source professional AI agent skills — all SkillSpec L3. Try them all in the browser · ⭐ Star on GitHub · Browse the full catalog