Providing Effective MTM

DECEMBER 01, 2006
Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief

In an era of shrinking dispensing fees, many of us have advocated a shift toward a new model for the profession—one based more on counseling and less on simply dispensing drugs. Medicare Part D, despite all the stress and problems it has generated, created just such an opportunity by including a requirement for medication therapy management (MTM).

Even though this part of the program is just getting started, the potential is considerable. A few plans have set up pharmacy-centered MTM services. For example, about 120,000 patients are required to receive MTM by the end of 2006 through the National Community Pharmacists Association's Community MTM program.

One might have expected pharmacists to jump on this, given the many surveys that have indicated we want to spend more time providing patient-focused services. Feedback to date, however, shows that many of us are not taking advantage of the opportunity.

Practical reasons for this exist. When resources are already overstretched, it is hard to justify hiring staff for a new, unproven line of business. Furthermore, each plan currently adds to our administrative burden by requiring us to learn and use a different system. Perhaps the biggest challenge is to change our own mindset so that we see ourselves as providers of services rather than just drugs.

By making this shift, pharmacists can position themselves to step into valuable new roles. Research suggests that MTM can reduce drug costs and, even more important, the risk of adverse interactions. The Part D MTM requirement covers situations in which patients are treating chronic conditions with multiple drugs—the type of situation in which pharmacists should excel in providing drug therapy advice.

Now, it is up to us to demonstrate that we are the profession best qualified to provide this service.We need to show both the ability and the desire to provide MTM, and to demonstrate that this is a valuable service both for patients and for plans.

If we accept the challenge and provide MTM effectively, we will begin to position pharmacists as valuable resources for advice. That, in turn, will pave the way for us to deliver more services in the future.

When creating the Part D MTM requirement, legislators did not specify who should deliver it, and many insurers are initially choosing to provide MTM by other means. If we do not demonstrate that pharmacists are the best providers of counseling services, we may be opening the door to allow others to claim that role.

Mr. Eckel is professor and director of the Office of Practice Development and Education at the School of Pharmacy, University of North Carolina at Chapel Hill.