Only a small fraction of MTM programs are open to community pharmacists
In creating the Medicare Part D drug benefit, the Centers for Medicare & Medicaid Services mandated that every PDP develop an MTM program. To date, the vast majority of MTM sessions are conducted by direct mail or over the telephone by pharmacy benefit managers and drug plan providers, leaving most community R.Ph.s with few options.
For many, the lack of involvement of community pharmacists in MTM represents a missed opportunity. "When the architects were designing this new benefit, MTM services were described as the 'cornerstone,'" of the plan, explained the American Pharmacists Association's president-elect Timothy L. Tucker, Pharm.D., in testimony before the Senate Committee on Finance in May. "But most plans have fallen short of the mark."
Walgreens' PBM division also administers an MTM program that uses both pharmacists employed by the PBM as well as its own store-based pharmacists. And Humana is one of the few major PDPs to offer its own program with significant participation of community pharmacists.
MTM programs continue to appear outside of the Part D program as well. Over the past few years, several pharmacy companies have begun to offer disease state management or MTM sessions to customers as a service, even without expectations of increased reimbursement from drug plans. "Winn-Dixie saw MTM as an opportunity," Mike LeBlanc, director of pharmacy at Winn-Dixie, told Drug Topics. "We viewed MTM as a perfect fit, a natural evolution of the job. And it's a great tie-in to Winn-Dixie's commitment to quality of care."
In addition, a number of private and government health plans have started to offer smaller scale MTM programs, most of which are administered by Outcomes Pharmaceutical Health Care. While most of these plans tend to be small and include a small population of MTM-eligible beneficiaries, they represent the largest potential for community-pharmacy-based MTM growth.
Note: For the most up-to-date list of MTM programs open to community pharmacists, visit http://www.drugtopics.com/. If you know of any other MTM programs that should be included in the Drug Topics Community Pharmacy MTM chart, please let us know at firstname.lastname@example.org