The subject today is what pharmacy's "big thinkers" have told us we'd soon not be doing — counting, pouring, licking, and sticking — and what we've been promised we'd be spending our time on ever since some Southern governor named Clinton was running for president and Nirvana was the hot new band ruling the pop charts: optimizing drug therapy to maximize patient outcomes.
Twelve years ago the pharmacy profession finally coalesced around a name and definition for a bright new future: medication therapy management, or MTM, the provision of services that include medication therapy reviews, pharmacotherapy consults, and all that other clinical stuff.
No, we won’t accept your Rx
Under that definition, what I spent a good chunk of my afternoon on the other day would certainly qualify as MTM, although maybe on a more basic level. It started with a call to an insurance company help desk.
“Yes, I'm getting a rejection for this doxycycline prescription. It must be some sort of mistake. It says you allow a maximum of one tablet per day.”
“Um, but the normal adult dose is two a day. And that's exactly how this prescription is written.”
It had taken a good five minutes on hold before I got this far, during which I managed to work in some good old-fashioned counting, pouring, licking, and sticking so that I could make some money.
“That dose would require a prior authorization.”
“It's the normal dose! It would make more sense for you to intervene if I were submitting a claim for only once a day!”
“Is there maybe someone else I could talk to?”
Back on hold. You know that default hold music that comes with so many phone systems these days? I know you'd recognize it if I could play a few seconds of it here. I'm now afraid I'll be hearing it in my head nonstop for the rest of my life.
No, we won’t transfer you
I kept the revenue flowing by getting some prescriptions out the door, a little more slowly than usual, as I had to keep an ear tuned to the speaker phone. Finally, a voice came on the line.
“Sir, you'll have to speak to the prior auth department.”
“Can you transfer me?”
“I can give you their number.”
It was then that I began to suspect that MTM actually stood for “May Take Millennia,” but I guess no one had ever promised me that a future of optimizing drug therapy would be easy.
No pharmacists need apply
More time on hold (although less, I noticed, than than the wait on the line pharmacists were normally expected to call); then a woman explained to me that prior auths could be granted only when a physician's office, not a pharmacy, submitted the relevant clinical information.
Ignoring her implicit rejection of my qualifications, I asked whether the package insert could be considered relevant clinical information, as it says clear as day that a healthy adult should get two tablets a day. I offered to fax a copy of it to her.
That got me back on hold. I decided MTM could stand for “Mightily Taking on Meatheads.”
I tried to distract myself from the hold music by imagining a board meeting of this insurance company’s top executives, where they were all baffled as to why their Star Ratings were so low.
No explanation, no apology
Finally a new voice came on the line and said coldly, “You can submit the claim now.” No explanation, no apology, no recognition of the absurdity of this whole situation.
I filed the claim and got paid $3 more than the product cost me — and nothing, of course, for the considerable length of time I had spent optimizing the drug therapy that wouldn't have needed optimizing if an incompetent organization hadn't stuck its nose where it didn't belong, in an attempt to save a few cents.
I doubt whether many pharmacies out there would have had the time I happened to have that day to spend on my MTM, which I guess puts me on the cutting edge of retail pharmacy practice.
I liked it better when I was just expected to count and pour, and had plenty of time to talk to the people at the counter. But I'll still take it over chickenization.