New Rx Management Role for Pharmacists in Medicaid Rules

Pharmacy Times, Volume 0, 0

A final version of the new MedicarePart D prescription drug program rulesissued by the Department of Healthand Human Services (HHS) will carveout a key role for the nation's pharmacistsin providing counseling and otherMedication Therapy Management(MTM) services to the nation's seniors.

A top goal of that new program,which will begin covering a significantpart of the cost of outpatient drugs forMedicare recipients in January 2006,will be "to optimize therapeutic outcomes"among elderly drug patients byassigning pharmacists the duty of providingMTM services.

Among other things, the final rulesenvision pharmacists performingMTM services to achieve a number ofgoals, including "enhanced enrolleeunderstanding"of drugs, "increasedenrollee adherence to prescriptionmedication regimens,"and the "detectionof adverse drug events"associatedwith prescription drug use.

The specific services that pharmacistswill be paid to provide underMedicare will include "performingpatient health status assessments, formulatingprescription drug treatmentplans, evaluating and monitoringpatient response to drug therapy?andparticipating in state-permitted collaborativedrug therapy management,"rule makers at HHS said.

Pharmacists will be compensatedfor these services by drug insuranceplans, which may not charge patients aseparate fee for MTM benefits.

Significantly, however, HHS refusedto specifically define a minimum packageof MTM services that all Medicarehealth plans must provide—a decisionthat is likely to create uncertainty forpharmacists and patients as the newdrug benefit takes effect early next year.

Even so, pharmacy leaders praisedthe new Medicare rules as a good "firststep"toward providing prescriptionbenefits to the elderly.

"While not every question isanswered in these regulations,"AmericanPharmacists Association ExecutiveVice President John Gans, PharmD, saidthat his group will continue to workwith Medicare regulators "to improveon this foundation, particularly the roleof pharmacists in helping consumerschoose their benefit plan, and in makingthe best use of their medicine throughMedicare-covered medication therapymanagement services."

Mr. Rankin is a freelance medical writer.