As the population of older people is expanding and medication review is both time consuming and money consuming, a more sophisticated approach to improve patient medication use might be necessary. An integrated combination of several medication therapy management techniques might therefore more efficiently improve medication effectiveness, medication safety and also increase the efficiency Currently, pharmacists are involved in multiple, often seldom integrated, pharmaceutical care activities like (among others) medication formularies, medication guidelines, clinical rules and patient education and adherence counselling. A possible way to integrate these different activities is the medication therapy management pyramid proposed in this article. The base of the medication therapy management pyramid is population-based care, whereas the top of the pyramid is patient-centred care. When conducting possible interventions on population level and by the adequate use of medication surveillance systems and clinical rules during dispensing, a medication review will shift from a system repairing overdue maintenance to an individualised medication coaching consult.