MTM as Pharmacy's Future

Published Online: Monday, August 29th, 2011

As a pharmacist, it is my duty to be correct 100 percent of the time. Correct medication, correct strength, to the correct patient at the correct time. If I am not correct, there may be some serious consequences.

Well today I am writing to say that I hope that I am not correct with what I am thinking, but from what I have been reading and researching, I just may be correct.

What is it that I hope I am incorrect about? It’s the thought that medication therapy management (MTM) is the model for the future of pharmacy. I’m afraid that the profession has gone all-in on this one practice model before the cards have even been dealt. Let me explain.

For the past 20 years, pharmaceutical care/medication therapy management has been touted to be the future of pharmacy practice. There have been a few projects that have shown how interventions by pharmacists can improve the quality of health care and decrease expenses for employers and insurers (Ashville, Diabetes Ten City). But these have not been able to be duplicated and rolled out across the country.

In fact, after 20 years, all we have are 3 CPT codes that we can bill our services under, but the insurers and Medicare do not recognize individual pharmacists as providers of medical services. We are still viewed by the product that we dispense instead of the services that we provide. It has only been in the recent past that the profession has been able to get language written that provides for grant money for MTM services. No funding yet, just language that might provide funding.

So where does that leave us today? Right now, the only MTM that is being provided (and compensated for) is to patients who are enrolled in Medicare Part D Prescription Drug Plans (PDPs). When the Medicare Modernization Act was passed several years ago, one of the selling points to pharmacists was that we were going to be able to provide MTM services to the Medicare Part D patients. At least with this, community pharmacists should be able to provide the MTM services to a segment of the population who should be able to benefit.

The 2011 CMS Fact Sheet on Medicare Part D MTM provides some insight on how the MTM services are being provided. According to the fact sheet, all of the Medicare D PDPs offer telephonic consultations. And 27 percent of the plans offer face-to-face consultations. Only 27 percent. That is sad. The Medicare D plans are not allowing their patients to receive MTM services from the pharmacists that they know and trust.

The service that is being compensated is a comprehensive medication review (CMR). For those of you who have never provided a CMR consultation, it’s basically a medication reconciliation with a Q&A session afterwards. After 20 years of hoopla, the future of pharmacy is a med-rec and a Q&A?

Since I began writing my blog, I have had the opportunity to talk with several national-level pharmacists who are in the know about MTM. Folks who are higher up the national organizations. From these conversations, I have learned that there aren’t any pharmacists who have been able to create a business model that is able to stand on its own financially. I have talked to a couple pharmacists who have been able to bill for their services and collect enough from insurers to cover their salaries and benefits. But these pharmacists have done so using billing codes that are “incident to” physician services, not utilizing the CPT codes that have been established for pharmacists.

If you have paid attention to recent articles, medication therapy management hasn’t been talked about as a service to be provided by community pharmacists. It’s now being thrown in as the pharmacist’s role in the medical home models and accountable care organizations (ACOs). It’s almost as if the national organizations have realized that medication therapy management as it was originally envisioned isn’t going to come to fruition so now they are trying to find a way to incorporate MTM into the ACOs so they can say that they were successful.

Like I said at the beginning, I hope I’m wrong about this. I want to see pharmacists able to bill for MTM services as individual providers. I want to see pharmacists recognized as individual practitioners by Medicare/insurers and not as extensions of the buildings that they work in. I want to see pharmacists reimbursed for the knowledge in their heads, not the pills in the bottle.

By embracing medication therapy management as the future of the profession of pharmacy, it seems to me that the national organizations and the pharmacy educators have gone all-in on this before the cards have even been shuffled, let alone dealt.