MTMS in Medicare: Critical to the Future of Pharmacy

Author: Edward J. Staffa, RPh

How long have you been a pharmacist? The chances are good, no matter how long it has been, that you have heard plenty about payment for nondispensing pharmacy services. Unfortunately, the chances also are good that you have seen little evidence of such payments. That situation may soon change.

By now, it is well known that the Medicare Modernization Act (MMA) of 2003, which goes into effect fully in January 2006, will cover prescription medications for Medicare beneficiaries. The MMA, however, calls for another critical Medicare service: Medication Therapy Management Services (MTMS). Beginning in 2006, the nation's largest payer of health care services, the US government, will pay for the medication management services of potentially millions of eligible Medicare beneficiaries. What an opportunity for payment for nondispensing services!

What exactly is MTMS? As a pharmacist, you may have a very clear idea of what such a service entails. After all, you do it every day. Unfortunately, however, there is no clear, widely accepted definition of this term in our health care system. Pharmacy is working hard to establish such a definition and, importantly, to make the pharmacist the primary provider of this service. In July 2004, the profession of pharmacy took a big step forward in helping to define MTMS. Convened by the American Pharmacists Association, 11 national pharmacy organizations hammered out a 1-page definition of MTMS (see Pharmacy Times, January 2005, page 72, or visit www.aphanet.org). We have been using that definition to communicate our vision of MTMS to others outside of pharmacy, such as the Centers for Medicare and Medicaid Services, the federal agency responsible for administering the Medicare MTMS benefit.

Will pharmacists provide Medicare's MTMS? The answer is up to us. The regulations governing the MMA, including those for MTMS, have just appeared. In those regulations, pharmacists are mentioned as possible MTMS providers, but the services are not being handed exclusively to us. Between now and 2006, many health care providers and health care organizations also will be looking to become MTMS providers.

In an age of Internet pharmacies, mandatory mail-order pharmacy services, and illegal importation of prescription medications from Canada and other foreign countries, it is more important than ever for pharmacists to demonstrate their value to the health care system. Providing effective MTMS represents a critical opportunity for our profession. Pharmacists are the ideal health care providers for MTMS. Let us step up and demonstrate that fact to all of health care. We will need the support of every pharmacist!

Mr. Staffa is vice president of pharmacy practice and communications at the National Association of Chain Drug Stores.