The results of this study highlight the challenges facing pharmacists who are practicing in a nonpharmacy setting and want to provide MTM. During the study period, almost one third of MPDPs used internal drug plan staff to provide MTM services. Despite their lack of proven effectiveness, many MPDPs offer MTM services via telephone communication or mailings.[3,12,13] There was difficulty in reaching representatives for the MPDPs, leading to an inability to determine how 65% of the MPDPs were conducting MTM services. A total of 162 patients (87.6%) were enrolled in plans that were not contracting with pharmacists to provide MTM services. Only one MPDP offered compensation for MTM conducted via a face-to-face encounter with a pharmacist. However, at the time of the study, this plan formed contractual agreements only with community pharmacies, not individual pharmacists.
Since the passage of the MMA, community pharmacists have successfully provided and been compensated for MTM services.[2,3] Pharmacists in North Carolina pilot tested an MTM program for state employees who volunteered to participate. During the program, pharmacists identified 3.6 potential drug therapy problems during the initial patient visit and 4 potential drug therapy problems at a follow-up visit.
The ability of pharmacists in ambulatory care settings to improve outcomes in a broader base of patients has been repeatedly demonstrated.[5,6,7,8,9] Pharmacists should have the ability to be compensated for the services provided. A 2007 survey found that 858,405 face-to-face patient encounters were provided by pharmacists in ambulatory care settings in 2006, only 26.5% of which were submitted for payment.
Pharmacists can overcome the barriers encountered during this analysis in several ways. First, pharmacists have the capability to work together to affect MTM compensation through policy change. Pharmacists can propose contracts that recognize the pharmacist, not the pharmacy, as the provider. Collectively, pharmacists may be able to change the way in which MPDPs develop contracts for MTM services. Because of the unified voice of the profession, one company is now offering contracts to nondispensing pharmacists to provide MTM services to their beneficiaries. These pharmacists receive referrals from the contractor to provide MTM services to patients whose own community pharmacies do not provide MTM services.
Some pharmacists have developed unique ways to overcome another barrier. Two pharmacists in Tennessee have obtained an NCPDP number from the state board of pharmacy for the explicit purpose of forming contractual agreements with MPDPs to provide MTM services. The pharmacists do not practice in a dispensing pharmacy and are prohibited from using the NCPDP number to purchase and dispense prescription medications (Eidson K. Tennessee Board of Pharmacy, personal communication, 2008 Apr 16). In the future, we suggest that MPDPs use the National Provider Identification number when forming contractual agreements with pharmacists to provide MTM services to avoid potential confusion.
Using one of these two methods in our practice could provide access to 12.5% of the patients eligible for MTM. However, over 85% of the patients in this report would still not have access to a face-to-face, pharmacist-provided MTM service within our practice because the plans either (1) provided MTM through internal staff or (2) did not have any information on their MTM services. While MTM has been haled as a breakthrough in pharmacists' compensation for cognitive services, many flaws exist in the current reimbursement structure. Several have been identified in this article and are not unique to our experience. The dearth of information available from many MPDPs regarding their MTM structure alone underscores the many barriers pharmacists face when attempting to establish a billable service.
This study had several limitations. First, it was an attempt to implement a new clinical service into a specific physician's office and was therefore descriptive in nature. Second, these results reflect a specific patient population and only 58.9% of the MPDPs available in Tennessee. Therefore, these results may not be generalizable to pharmacists practicing in other locations. However, a similar analysis may be conducted by pharmacists practicing in a comparable practice setting to determine the feasibility of contracting with MPDPs to provide MTM services.
Future MTM programs should consider the inclusion of pharmacists who are not based in a pharmacy as providers of MTM services. As the landscape of MTM continues to change, pharmacists should continue to strive to overcome barriers to implementing billable MTM services.
Am J Health Syst Pharm. 2009;66(15):1390-1393. © 2009 American Society of Health-System Pharmacists
Cite this: Feasibility of Contracting for Medication Therapy Management Services in a Physician's Office - Medscape - Aug 01, 2009.