More supermarkets are getting into the drug counseling business and are expecting it to add significant dollars to their pharmacy bottom lines.
Medication Therapy Management — known widely as ‘MTM’ — came to prominence as a reimbursed service of the Medicare prescription drug benefit, which became effective Jan. 1, 2006. Now MTM services are quickly spreading beyond Medicare to other types of medical coverage, attracting the interest of commercial health insurance companies, employer groups, prescription benefit managers and even individual patients.
Some retailers report that these other payers now represent a bigger part of their fledgling MTM service than Medicare.
“We are working with payers like Community MTM Services and others to develop for-fee MTM services in our stores,” said Donald Clark, vice president of pharmacy operations, K-VA-T Food Stores, Abingdon, Va.
With MTM, patients with multiple conditions or medications are referred to pharmacies for counseling sessions, and then the pharmacy is paid for its time. Retailers report that the benefits of MTM include heightened customer loyalty to their pharmacies, greater job satisfaction among pharmacists and potentially increased revenue, although a financial investment in the program in its early stages is necessary.
Because it was instituted by Medicare Part D, many in the industry still regard MTM as primarily a Medicare offering, but retailers and other experts told SN it has the potential to become much bigger. It won't be the first time that Medicare has brought about changes in other medical sectors.
“This is a case where a Medicare-driven initiative can show that it can ultimately lower costs,” Clark said. “This will expand, and there will be more opportunities available.”
“Where Medicare goes, so goes everyone else,” said Jaime Hendrickson, manager, MTM services, Supervalu Pharmacies, Franklin Park, Ill., during a session at the recent Food Marketing Institute Pharmacy Conference in Chicago, where many retailers were interviewed for this story.
Supervalu's MTM program, which is expanding rapidly, includes not only Medicare and Medicaid patients, but also those covered by insurance companies such as Humana, Louisville, Ky., Hendrickson said. Supervalu began last year with eight specialists covering about 90 Chicago-area stores, but has since expanded that number to 25 specially trained pharmacists covering 200 stores, and the chain expects to have 60 specialists covering 500 stores by September, she said.
“In total, the demand is certainly growing. On a weekly basis, I hear about new payers, so digging deep and finding out what they are all about is something that I am constantly challenged with,” Hendrickson said.
While the Medicare portion of MTM is growing, “we are seeing more and more private providers looking at MTM, and they certainly are looking at the pharmacies and pharmacists that are providing those services,” said John Fegan, senior vice president, pharmacy, Ahold USA, Quincy, Mass. “We happen to be providing them in the Maryland area, and we are doing some of it up in New England, and we are being paid for it.”
For example, a private major insurance group that Ahold works with will look at the medications its members are taking, and then send a list of people getting new medications who should be counseled or followed up with. Ahold will be reimbursed for its services.
If a person on the list isn't contacted within a certain period of time, “the insurance company gives it to another pharmacy to follow up on. We are getting more and more of those being referred to us because some pharmacies aren't following up,” Fegan said.
“So we are blazing some trails here. We are breaking some barriers,” he said.
“As we continue to demonstrate the value of pharmacy and cost savings to the payers, Medication Therapy Management will continue to accelerate and become more accepted, and we will be paid for those services,” said Curtis Hartin, senior director of pharmacy, Bi-Lo, Greenville, S.C.
Besides participating in the Diabetes Ten City Challenge of the American Pharmacists Association Foundation, Washington, Bi-Lo also is “in the process of developing our own suite of service offerings,” he said. “If we've got patients with complicated chronic diseases, or patients with a polypharmacy [multiple prescription drugs] situation, we can help them manage their medications,” Hartin said.
“We'd like to make Medication Therapy Management a standard of practice at Ukrop's,” said John Beckner, director, pharmacy and health services, Ukrop's Super Markets, Richmond, Va.
The retailer is working with Humana and Community Care Rx, he said, adding that many people besides Medicare recipients can benefit from MTM delivered by pharmacists.
MORE THAN PART D
“MTM is not just about Part D,” said Kurt Proctor, chief pharmacy officer, Community MTM Services, Alexandria, Va., a company owned by the National Community Pharmacists Association. It provides retailers a Web-based common platform presenting the documentation from various MTM programs.
“Certainly, the new Medicare prescription benefit put MTM in the spotlight — and even made the term part of our profession's lexicon — but pharmacist-delivered patient care services, including MTM, are being implemented by public and private insurers, as well as by employers. Appropriately used medications lower other health care costs and increase ‘presenteeism’ and productivity,” Proctor said.
“MTM is not just the province of Medicare Part D,” said Bruce Kneeland, president, Pharmacy Connections, Valley Forge, Pa. “The idea works on patients no matter the payer. Progressive pharmacists will search out and work with payers to assure them they can provide this service to all their eligible patients,” he said.
“It clearly is providing services that the patients value,” Proctor said. “It helps build on the relationship that the pharmacist already has with the patient, and it strengthens that relationship. It puts the pharmacist in the light of being a true health care provider, and not just a dispenser of medication.”
With the pharmacist shortage, MTM helps make retailers more attractive employers. “Providing these kinds of services is what most pharmacists prefer to do, and certainly it is what the new ones are looking to do. So it's a competitive advantage on the hiring side,” he said.
MTM also is a revenue opportunity, “and it will grow to be a bigger one over the short term,” Proctor said. This is important as pressure on pharmacy margins continues, whether from low-priced generics or decreased Medicaid reimbursements, he noted.
This kind of patient service helps position pharmacy as an integral part of the larger health care system, Proctor said.
MTM is something that pharmacy has got to get behind, said Dan Milovich, director, pharmacy operations, Bashas', Chandler, Ariz. “We have no options. We have to look at another way to bring profit into the pharmacy, and this is obviously something that we can do for our patients,” he said.
The Medicare Part D program and its recipients remain at the core of MTM, “but there's potential for all patients, and it's a win-win for the pharmacy and the customer,” said Michele Snider, senior director of pharmacy, Save Mart Supermarkets, Modesto, Calif.
“It certainly creates loyalty in that customer. They can keep coming back and get to know their pharmacist personally, which can help them with their disease states,” she said.
What is Medication Therapy Management?
Medication Therapy Management is a health care service provided by a qualified health care provider, such as a pharmacist, to help patients and/or caregivers optimize the benefits of medication, minimize risks associated with medication use and maximize the cost-effectiveness of medication therapy. Preferably, MTM services are conducted one-on-one and face-to-face between patient and health care provider. MTM services do not need to be provided in conjunction with the provision of a medication product.
MTM can include the following services:
- Performing or obtaining assessments of the patient's health, including known allergies, laboratory measurements and medical conditions.
- Performing a review of all prescription and over-the-counter medications taken by the patient to identify, resolve and prevent medication-related problems.
- Helping patients understand the appropriate use of their medications.
- Helping patients take their medications properly.
- Formulating a medication treatment plan.
- Selecting, initiating, modifying or administering medication treatment.
- Monitoring and evaluating the patient's response to medication.
- Accurately recording the services delivered to the patient and communicating the necessary information to the patient's other health care providers.
Source: Ed Staffa of Community MTM Services at www.rxwiki.com