Viewpoint: Bigfoot, Loch Ness monster, medication therapy management

September 17, 2007

Most pharmacists are still not providing medication therapy management, although it is required by law under Medicare Part D.

Answer: Bigfoot, the Loch Ness Monster, and medication therapy management (MTM).

Now, before you take offense, ask yourself the following question: Do you, as a practicing pharmacist, provide and promote MTM?

Back in the spring of 2002, I spent a good amount of time on Capitol Hill lobbying lawmakers in support of House Resolution 3626. This piece of proposed legislation provided recognition of, and payment for, R.Ph.-provided MTM services. Oh boy!

Just a few short years ago, I eagerly attended a town-hall style debate at a major pharmacy conference. On one side of the debate were the good guys: the independent community pharmacists. On the other side was the evil empire: Medco and its dangerous mail-order machine. The debate was moderated by TV's Chris Wallace and had all the hype of a heavyweight fight. The early rounds were won easily by the community pharmacists touting a menu of hands-on patient care. Hooray for our team!

But the knockout punch came in the final round, when the lawyer for Medco said (and I'm paraphrasing here), "I hear your arguments about community-based pharmacy care, and it sounds wonderful. But I'm nearly 60 years old, and I have been a pharmacy consumer for longer than I'd like to admit, and I have yet to see any of these special services you're describing. As a practical matter, they don't exist." Ouch.

The latest chapter in this saga would be funny, if it weren't so full of sad irony. Finally, on Dec. 8, 2003, after a contentious journey through the 108th Congress, the Medicare Prescription Drug Improvement and Modernization Act of 2003-Medicare Part D-was signed into law by President Bush. And, the only provision of that law that passed through the conference committee with unanimous support was MTM. Hallelujah!

Not so fast. In 2005, CMS wrote that ". . . until the Pharmacist Provider Coalition's recent publication of its definition of a medication therapy management program [MTMP], no widely agreed upon definition of MTMP existed, let alone standards and measures."

As a result of that CMS finding, MTM is now whatever the prescription drug plans say it is. To the best of my knowledge, this federal legislation that requires MTM services to be provided to Medicare beneficiaries, and that the provider of MTM services be paid, has had virtually no measurable effect on either the practice of pharmacy or the value of pharmacy reimbursement. At this point in time, any reasonable person must concede that MTM indeed does not exist.

But that seems impossible. How can a concept so simple-MTM, or pharmacists helping patients manage their medicine-become so lost and twisted that, for all practical purposes, it has ceased to exist? I simply cannot accept my own logical conclusion.