Medication Therapy Management (MTM) — a broad range of pharmacy consultative services to maximize medication effectiveness and use — should get a boost in 2011 when the first of 80 million Baby Boomers turn age 65.
Check out these statistics submitted in a report, “Medication-Related Problems in Older Adults: A Hidden and Costly Epidemic,” by the American Society of Consultant Pharmacists, to President Obama's transition team last year:
Medication-related problems cost over $200 billion in direct health care costs.
Although people over age 65 make up only about 12% of the population, they account for over 36% of all reported adverse drug reactions.
Adverse drug reactions and noncompliance are responsible for 28% of hospitalization in the elderly and 23% of nursing home admissions.
Researchers estimate that about 25% to 30% of all medication-related problems are preventable.
While demand for MTM will be high, rising health care costs, a pullback in government support, and barriers to implementation of MTM services could curtail MTM progress in becoming a viable component of integrated health care.
Supermarkets to date have embraced MTM to various degrees. Cathy Polley, vice president of pharmacy services, Food Marketing Institute, Arlington, Va., said that 83.6% of supermarket pharmacies offer MTM services or plan to implement such service. The vast majority (96.3%) of all supermarket pharmacies offer MTM services in at least one location and are compensated for those services.
More than half of reimbursements to supermarket pharmacists for their clinical services are paid for by pharmacy benefit managers, 24% by Medicare and 8% by patients, said Polley.
While the majority of the food chains are practicing some form of MTM, most would agree that MTM practices are still evolving.
Jim Wonderly, vice president of pharmacy for Ahold's Stop & Shop/Giant Food, Quincy, Mass., said his organizations have limited experience with MTM in a few pharmacies in Maryland. “There is still much work to be done to educate the consumer and develop an effective staffing model,” he added.
Chains such as Minneapolis-based Supervalu have long pursued developing MTM programs in partnership with others. Medication Management Systems (MMS), also based in Minneapolis, a provider of MTM software and support services, is one such partner and is running a pilot with Supervalu in 22 Minnesota stores.
Supervalu could not be reached for comment, but Tom Albers, a founder of MMS and vice president of sales and marketing, said Supervalu has about five MTM-trained pharmacists, who rotate through the stores to conduct 30-minute patient assessments. The assessments are by appointment only.
MMS advocates a full patient assessment and follow-up. Albers said that MTM delivered in intervals (very brief advisory sessions) during the course of routine dispensing has proved less effective than full patient assessments that require 30 minutes or more of counseling. Reimbursement rates for such service are also higher — $90 as opposed to $8 to $10 for a several-minute consultation.
“Reimbursement is critical, but having a practice a payer can understand is equally as critical. There are 25 versions of MTM. This only confuses patients and payers,” said Albers. “This is an effort to coordinate care, and that is where health care reform and medical reform comes in as well. We cannot have health care providers performing as an island. The costs are too high.”
John Fegan, vice president, pharmacy, Winn-Dixie Stores, Jacksonville, Fla., said the 405 pharmacies in the chain are well into MTM practices. Pharmacists concentrate on patient compliance. Once the pharmacist is assured patients are properly taking medications, Winn-Dixie then focuses on the medical condition. Fegan said protocols have been written by Winn-Dixie pharmacists for diabetes, women's health and cholesterol/hypertension. Pharmacists are also looking at Coumadin therapy, using the blood-thinning drug.
Winn-Dixie also offers free quarterly health screenings in partnership with Bayer and Cholestech. This gives pharmacists an opportunity to alert patients to Winn-Dixie's MTM services.
Working in conjunction with the American Pharmacists Association, Fegan said all of Winn-Dixie's pharmacists will be trained in inoculations. “The services our pharmacists will provide are going to be as valuable or more valuable than medications dispensed.”
Winn-Dixie is part of the Outcomes Pharmaceutical Health Care network. Outcomes, based in Des Moines, Iowa, is another facilitator of MTM services, with an emphasis on integrating MTM as part of the total pharmacy practice, including dispensing.
“We allow pharmacists to bill for services that occur within the workflow of the pharmacy. Picking up the phone to call a doctor about a formulary medication is a payable service in our program and can be billed. We have tools to help the pharmacy integrate that into the regular workflow of dispensing,” explained Brand Newland, Outcomes vice president.
Just how far MTM can be developed with support from the new Obama administration is anybody's guess.
But Anne Burns, a pharmacist and vice president of professional affairs for APhA, warns that the health care reform debate is moving very rapidly. She said legislation could be introduced by early summer. “We're calling on pharmacists to be very engaged in this debate, and for those providing MTM services to invite congressional representatives and senators during the mid-April break to visit their local pharmacies to see the work being done.”
A positive sign comes with the Centers for Medicare & Medicaid Services' 2010 draft call letter proposal for new mandatory standards for Part D MTM programs. The new standards may make it easier for patients to qualify for MTM services, and it may lower the annual drug spend from $4,000 to $3,000. The final standards are expected in April.
According to CMS, less than 7% of Medicare Part D beneficiaries are eligible to receive MTM services under the eligibility requirements of existing Part D MTM programs, and only a small percentage of eligible beneficiaries are actually served.
Bruce Kneeland, president of Pharmacy Connections, a consulting firm in Valley Forge, Pa., said grocery stores are best positioned to deliver MTM. The food retail channel offers the added value of the whole store combining nutrition for improved and better health. “You have frequency of visit, close proximity to the patient. Most grocery store pharmacies are underperforming, so the pharmacist has the time to be involved. That platform is the basis of success,” Kneeland said.