The Medicare Prescription Drug Improvement and Modernization Act of 2003 required private insurance plans to offer medication therapy management (MTM) programs for enrollees. MTM is a service that holds great promise for community pharmacists. It is an opportunity that should not be overlooked because it can improve patient outcomes and provide an additional revenue stream for pharmacists.
Medicare reimbursement for MTM services is targeted toward beneficiaries who meet their insurance companie's Medicare Part D plans' criteria and the Centers for Medicare & Medicaid Services' minimum guidelines. First, the patient must have multiple chronic disease states. Second, patients must be taking multiple Part D?covered medications. Finally, patients must be likely to incur $4000 in yearly prescription- medication costs.
Increasing Demand for MTM
"MTM continues to present tremendous new business opportunities for us. The demand for MTM services has increased dramatically, especially for medically complex patients residing outside nursing facilities," said Joseph Gruber, president of the American Society of Consultant Pharmacists (ASCP), during his opening remarks at the association's recent Senior Care Pharmacy meeting and exhibition.
In an effort to help ASCP members deliver clinical services in the community without having to find new patients and establish business support services, ASCP created the MTM Provider Partners program. It offers opportunities for members to provide community-based MTM consulting services. PharmMD Solutions is one of the MTM Provider Partners looking to ASCP to help them sign up consultant and senior care pharmacists to deliver MTM services directly to their contracted enrollees.
The Brentwood, Tennessee?based PharmMD, launched in 2006, is an MTM company that works with pharmacists and pharmacies through its Independent Contractor Agreement. The company's documentation system and call-center technology enables pharmacists to deliver MTM services through both face-to-face consultation and telepharmacy.
Brad Tice, PharmD, chief clinical officer for the company, was a member of the team that wrote the accepted clinical definition of MTM approved by 11 organizations. He also participated on the advisory panel that developed the MTM model jointly issued by the American Pharmacists Association (APhA) and the National Association of Chain Drug Stores.
"It is not just about the product. It is about taking the medications correctly. If medications are not taken correctly, patients will never see the value," said Dr. Tice. "Medication error, overuse, and abuse are pressing issues in today's health care environment, and, if applied properly, the principles of MTM can go a long way toward preventing these negative events," he added. "It is exciting to operate on the cutting edge of such an important health care trend."
As a pioneer in his field, Dr. Tice was 1 of 17 individuals to receive the APhA Fellow Award in March 2008. The APhA Fellow Award was established in 1987 to honor members who have demonstrated progressive, exemplary service, and achievements in their professional area through service to APhA academies and other national, state, and local professional organizations.
When MTM services began under Medicare Part D in 2006, Cardinal Health started offering enrollment assistance to pharmacists participating in the LeaderNET program. Currently, >3300 independent pharmacies are members of Cardinal's Leader program, which provides retail independent pharmacies with many of the same advantages as retail chains, and about 2200 pharmacies participate in LeaderNET.
Registered Pharmacist Glenn Hall, general manager of Leader Member Services and vice president of marketing for Cardinal Health's managed care group, said it is crucial for pharmacists to provide MTM services for 3 main reasons: (1) they help improve patient outcomes; (2) they help reduce health care costs; and (3) they provide pharmacists with the opportunity to be reimbursed for sharing their knowledge and expertise with patients.
Benefits for Patients
Hall believes MTM offers many benefits for patients. "Because MTM services help patients better understand the purpose of their medications and how to best use them, MTM services help prevent adverse reactions and medication complications, while improving compliance with prescribed directions. It not only leads to improved patient outcomes, but also to lower overall health care costs."
The LeaderNET program provides many types of assistance to help pharmacists begin MTM services. For example, information for all MTM services and network opportunities is available at www.myleader.com, along with a free pharmacist help line. Leader Pharmacies also sponsored a 17-city educational tour to teach community pharmacists how to provide MTM services, and LeaderNET has been working with pharmacists on staff and students at the University of Findlay School of Pharmacy in Ohio to coach pharmacists about MTM and how to become involved.
"MTM is an opportunity that all pharmacists should take advantage of now," said Hall. "For MTM to be adopted in the commercial market, pharmacists must step up, prove the value of the services, and justify the associated fees. As a result, all players in the health care supply chain will benefit. To make a sizable impact, pharmacists will need to become very aggressive and train staff members to provide MTM support so that pharmacists can work caseloads as efficiently as possible."
Documentation Is Key
Kurt Proctor, RPh, PhD, chief pharmacy officer for Mirixa Corp, said that pharmacists already have been providing many elements of MTM. "Historically, however, pharmacists have not done a lot of documentation. If we do not document, no one is going to see the value of the services pharmacists provide."
In addition to providing MTM services, Mirixa Corp is a developer of clinical solutions that facilitate pharmacistbased patient care services. The company has delivered >70,000 MTM services within its national pharmacy network since its launch in June 2006. Currently, thousands of pharmacies nationwide use MirixaPro—the company's ondemand clinical software suite. MirixaPro:
- Delivers comprehensive patient information and proactive clinical alerts to highlight potential opportunities for pharmacists to help patients with their medication— from education, to staying on their medication, to finding better alternatives
- Assists in managing patient relationships through software designed with the pharmacist's work flow in mind, including patient queuing, scheduling, documentation, and contact management
- Streamlines documentation and billing for pharmacy-based patient care services
- Creates new opportunities for pharmacists to be reimbursed for delivering medication-related services to their patients
The company recently launched its MirixaPro 2.3 product. The program is available in >80% of US pharmacies.
Pharmacists wanting to participate in MTM services through Mirixa can receive online and live WebEx training. The training program details how to use the Web site and provides specific instructions in providing and billing for MTM services. Using the online system, pharmacists can identify patients who qualify for MTM, schedule face-to-face appointments for patients, document the visit, and bill for services.
Dr. Proctor feels it is crucial for pharmacy to position itself stronger as a health care provider. "It is important for pharmacists to be engaging in these services. From the patient side, they have health care needs, and pharmacists are in a position to help. Engaged pharmacists result in a higher quality of patient care. Pharmacists really need to stand up and do this [MTM]," he concluded.