Viewpoint: MTM must be expanded for pharmacy to stay relevant

January 14, 2008

Pharmacists must find creative ways to offer medication therapy management services and get paid for them.

You bet they are! Our facility, a major health system, has been performing comprehensive ambulatory MTM services since 2003. Although we have contracted with pharmacy benefit managers to perform MTM functions and we have a retail pharmacy, we have not, however, modeled our practice after a chain or PBM.

We are fortunate to have in-house physicians who support our practice with referrals, but many of our patients evolve from self-referred requests to their physician. They want to talk about their medication with a pharmacist. There is a public demand for these services! It is up to enterprising pharmacists to step outside the pharmacy box, educate the public and the medical profession, and market their services!

To be professionals who are respected for what we know and NOT for what we sell, a few things must take place. First, access must be limited. Patients have to make appointments in order to see a doctor, attorney, dentist, or chiropractor. Why shouldn't they for comprehensive pharmacy services?

Second, physicians must understand that you are partnering with them to improve outcomes for their patients and not to get into their wallets. We can, in fact, become an important referral source for physicians! How many of us in the community pharmacy triage patients on weekends or evenings, when physicians are not available, to help patients decide to use an OTC product for their condition, see the doctor, or in some cases go to an emergency room?

Third, we cannot as a profession let others define what we are and what we do. The PBM model defines MTM as keeping patients adherent to their medication schedules, keeping them on medications that match their formulary, and generally performing services that are favorable to the PBM at the lowest cost possible to the PBM. It is not that these services are not valuable to the patient. They are. But the services are defined from the PBM point of view. This business model is not necessarily the best business model for pharmacy practice, because compensation for these services, like compensation for services in filling prescriptions, is inadequate to cover the true costs in delivering these services to patients.

Many will say MTM cannot be done because reimbursement levels are not enough to cover costs, which is a valid point. But, since one must crawl before one can walk, I would suggest a phase-in of the services into practice. In the current structure we have, we are able to cover 60%-80% of our labor costs depending on time spent with the patient and use of non-pharmacist leverage. With projected adjustments soon to be made, we can be breaking even or making money in as little as six to 12 months on a per-consult basis. We have been aggressively marketing the service for less than a year.

If potential patients are turned off by non-coverage by insurance and out-of-pocket costs, start at lower fees, then work your way up over time after the practice is established. One must tailor one's practice to the population one serves. If the local family-medicine group has mostly working-poor patients, offer a practice "membership" to your services of a few hundred dollars a year to offset the service costs to see these patients and throw in an in-service quarterly to the clinical staff or perform drug information services for them. Be creative!

If pharmacy as a profession continues to take a backseat to physician assistants, physical therapists, occupational therapists, speech pathologists, audiologists, and the like and remains politically inert on the subject of rendering professional services, we as a profession will become irrelevant.

Current procedural terminology (CPT) codes for MTM services are the key to unlocking the product ball and chain from the pharmacy profession's ankle in both institutional and community practice. It is incumbent upon pharmacists to unlock and remove the ball and chain. We all know what happens when we do nothing... Nothing!

THE AUTHOR is an ambulatory/community pharmacist who practices in Jacksonville, Fla. You can reach him at SchwaRx1@comcast.net
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