New medication therapy management programs are expanding community practice opportunities.
To qualify as Medicare Part D plans, prescription drug plans (PDPs) are required to submit an MTM program. In 2007, there were 613 programs, up from 553 in 2006. Of those, nearly half (48.8%) were administered entirely by in-house personnel at the PDP, while 26.6% were handled entirely by outside staff, including pharmacists, nurses, doctors, and contractors. The remaining 24.6% of plans used a combination of in-house staff and outside personnel. Even though the overall number of plans using outside providers at least some of the time fell by 3% between 2006 and 2007, Michelle Ketcham, Pharm.D., of CMS' Medicare Drug Benefit Group explained at the National Association of Chain Drug Stores Pharmacy & Technology Conference. "We are seeing an increase in community pharmacy," she said.
According to CMS data, the plans were extremely diverse. In 2007, for example, 62 MTM programs required that beneficiaries take at least two covered drugs, while 43 plans required 10 or more covered drugs (one plan required the beneficiary to be on at least 23 medications). Similarly, although nearly half of the programs required a minimum of two chronic diseases, 6.5% required at least five disease states. The top diseases for coverage were: diabetes, heart failure, hypertension, asthma, and chronic obstructive pulmonary disease (COPD).
At least one additional national PDP will offer community pharmacist-administered MTM for the 2008 plan year. HealthSpring recently announced that it would offer MTM services through Outcomes Pharmaceutical Health Care. Currently HealthSpring has approximately 80,000 beneficiaries enrolled in its Medicare Part D PDPs nationwide. As in other Outcomes MTM programs, all beneficiaries will be eligible for medication checkups from Outcomes-trained pharmacists.
Of course, MTM programs are also expanding beyond the limitations of the Medicare program. Wisconsin Pharmacy Quality Collaborative (WPQC), a quality improvement organization (QIO), recently unveiled a new program that will launch in November. The program will begin with close to 50 pilot pharmacies. Interestingly, WPQC developed the program with help from McKesson, but it is not tied to a single health or prescription drug plan. According to Stefan Linn, senior VP of marketing for McKesson U.S. Pharmaceutical, payment will come from prescription drug plans that are committed to the program.
University of Michigan faculty have developed another similar program-although they stress that the goal is not higher reimbursement, but rather better quality of care. The program is for university alumni and staff and their dependents, and any beneficiary taking at least nine medications is eligible. The goal will be to reduce plan costs, but the university has also agreed to hire an additional pharmacist to handle the extra workload. "We differ from Medicare Part D MTM programs in that this is a benefit from the university to people for whom we think there is a chance that we can optimize therapy," explained Leslie Shimp, Pharm.D., professor of pharmacy at the university, who helped develop the program.
One of the greatest benefits of the program will be the data collected and the possibilities of in-depth analysis of the outcomes and cost savings the program generates. "We have a center for medication use policy and economics that will evaluate the program," added Shimp. "The clinician group is also excited that we are creating an electronic history, and we see potential benefits beyond this program."