New Rx Management Role for Pharmacists in Medicaid Rules

APRIL 01, 2005
Ken Rankin

A final version of the new Medicare Part D prescription drug program rules issued by the Department of Health and Human Services (HHS) will carve out a key role for the nation's pharmacists in providing counseling and other Medication Therapy Management (MTM) services to the nation's seniors.

A top goal of that new program, which will begin covering a significant part of the cost of outpatient drugs for Medicare recipients in January 2006, will be "to optimize therapeutic outcomes" among elderly drug patients by assigning pharmacists the duty of providing MTM services.

Among other things, the final rules envision pharmacists performing MTM services to achieve a number of goals, including "enhanced enrollee understanding"of drugs, "increased enrollee adherence to prescription medication regimens,"and the "detection of adverse drug events"associated with prescription drug use.

The specific services that pharmacists will be paid to provide under Medicare will include "performing patient health status assessments, formulating prescription drug treatment plans, evaluating and monitoring patient response to drug therapy?and participating in state-permitted collaborative drug therapy management," rule makers at HHS said.

Pharmacists will be compensated for these services by drug insurance plans, which may not charge patients a separate fee for MTM benefits.

Significantly, however, HHS refused to specifically define a minimum package of MTM services that all Medicare health plans must provide—a decision that is likely to create uncertainty for pharmacists and patients as the new drug benefit takes effect early next year.

Even so, pharmacy leaders praised the new Medicare rules as a good "first step"toward providing prescription benefits to the elderly.

"While not every question is answered in these regulations,"American Pharmacists Association Executive Vice President John Gans, PharmD, said that his group will continue to work with Medicare regulators "to improve on this foundation, particularly the role of pharmacists in helping consumers choose their benefit plan, and in making the best use of their medicine through Medicare-covered medication therapy management services."

Mr. Rankin is a freelance medical writer.