Drug Topics - December 8, 2008 - (Page 4) Professional MEDICATION THERAPY MANAGEMENT Fred Gebhart, Contributing Editor Indiana pharmacists identify MTM barriers Not sure how to jump into the growing field of medication therapy management? You’re not alone. Purdue University researchers found nine barriers that are keeping most pharmacists out of the MTM market. “MTM is the first attempt by managed care to pay pharmaBurns said. cists for professional services,” said Christy Nash, assistant cliniPurdue researchers surveyed pharmacists across Indiana in cal professor of pharmacy practice, Purdue University School 2007 and conducted in-depth interviews on RPh attitudes and of Pharmacy. “The service component is a no-brainer for most practices in providing MTM services. pharmacists. It is the process of being recognized as providers In addition to lack of adequate space for MTM, Indiana and getting paid that we don’t have in place." pharmacists identified lack of adequate reimbursement, lack The key barrier to providing MTM services is unclear or of time, lack of MTM-specific training, and problems commuincomplete provider guidelines and adjudication procedures nicating with prescribers as barriers to effective MTM practice. from managed-care organizations that pay for services, Nash Lack of management support also emerged as a common said. Medicare Part D requires MTM for patients who have problem. multiple chronic conditions, use multiple “There are some significant MTM opmedications, and are paying at least $4,000 portunities for pharmacists out there, but “Too many pharmacists Part D plans are not getting enough pharannually out-of-pocket for covered medications. But while Part D requires MTM macists participating,” Burns said. “We have either washed services for millions of patients, nothing in hear from pharmacists that they don’t get their hands of the law or regulation requires that MTM be enough cases to make the business model whole concept or provided by pharmacists. work.” have gone back to There are no standardized definitions APhA’s experience matches Nash’s providing services for of MTM as there are for more established findings that administrative barriers are a free in order to avoid Medicare or Medicaid services furnished key reason that pharmacists are not more by physicians, hospitals, and other providactive in providing MTM services. Manthe complexities and ers. And there are no nationwide stanaged care organizations are not providing frustrations of seeking dards for provider eligibility, patient eligireliable or predictable numbers of eligible payment. ” bility, reimbursement rates, or payment patients. — Christy Nash, assistant clinical professor mechanisms. Chains are in a stronger position than of pharmacy practice, Purdue University School of Pharmacy “The managed care requirements and independents to provide MTM services, she criteria for patients to qualify for MTM is said. Chain operations can funnel MTM an issue,” Nash said. “We see so many patients from multiple stores to a single more patients who need these kinds of services than could pharmacy in order to build a steady MTM practice. Indepenpossibly qualify under MTM programs. We are being told who dents must rely on referrals from Part D drug programs. to help and how to help them with different requirements “You may have ten patients in June and they may not from every Part D drug program." give you anybody else until October,” Nash said. “That’s not a Physical issues such as lack of private consultation areas also business model.” discourage both patients and pharmacists from taking advanThe pharmacy reimbursement process is also a barrier. tage of MTM opportunities. “There have been several reports Every managed-care plan has its own payment system and out this year that highlight similar findings,” said Anne Burns, timetable, Nash said. That complicates cash flow and business vice president of professional affairs for the American Pharplanning. macists Association. APhA published its own MTM survey in “My pipe dream is for MTM reimbursement to become as March. CMS, the Centers for Medicare and Medicaid Services, simple as a billing code that is adjudicated and paid as directly published an MTM report in July. “It is very important that as the medication component,” she said. “MTM service paywe have the time and the space to provide these services,” ment should be as direct as a drug product payment.” 4 DRUG TOPICS D E C . 8, 2008 W W W.D R U GTO P I C S .C O M http://WWW.DRUGTOPICS.COM
Table of Contents Feed for the Digital Edition of Drug Topics - December 8, 2008 Drug Topics - December 8, 2008 Medication Errors - Take 5 Indiana Pharmacists Identify MTMBarriers Drug Topics - December 8, 2008 Drug Topics - December 8, 2008 - Drug Topics - December 8, 2008 (Page 1) Drug Topics - December 8, 2008 - Drug Topics - December 8, 2008 (Page 2) Drug Topics - December 8, 2008 - Medication Errors - Take 5 (Page 3) Drug Topics - December 8, 2008 - Indiana Pharmacists Identify MTMBarriers (Page 4)
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