Supermarket pharmacy executives are preparing to get a lot closer to their patients.
While it is certain the Medicare Part D Prescription Drug Benefit will be put into action in January 2006, one undefined aspect of the legislation continues to excite, yet concern, retail pharmacy:
Medication Therapy Management. Medication Therapy Management is a distinct service that may be provided by pharmacists to counsel patients in managing multiple drugs. Pharmacy executives see it as holding great potential, but also great uncertainty as they wait for the federal government to define the program.
The Medicare Part D legislation allows payment for these services, but it does not require payment nor does it stipulate an amount. Moreover, pharmacists are not the only entity permitted to provide these services; MTM is open to any type of health care practitioner. "MTM represents a great opportunity for pharmacists to have a positive impact on health care and have it recognized by the government and plan providers," said John Beckner, director of pharmacy and health services, Ukrop's Super Markets, Richmond, Va.
With the adoption of pharmacist-administered MTM, "pharmacists will be recognized as an essential health care provider and a true part of the patient's overall health care protocol," said Dan Milovich, district pharmacy manager for Bashas' Markets, Chandler, Ariz.
Under Part D, health insurers or prescription benefit management companies contract with the government to offer benefit plans. Some have partnered with retailers, such as Cigna, Philadelphia, and Ahold USA, Braintree, Mass., and Aetna, Hartford, Conn., and H.E. Butt Grocery Co., San Antonio.
Beneficiaries will be able to choose among different plans and sponsors, with sign-up beginning Nov. 15.
It is up to each independent plan provider to decide if retail pharmacy will administer MTM. A plan provider could also administer MTM internally through phone counseling or by other means, such as nurse practitioners or reminder letters.
While promotion of Medicare Part D plans began in October, the fate of reimbursable MTM remains largely unknown to retailers.
"Since the government is dealing directly with plan benefit managers, MTM information hasn't filtered down to retail," said John Fegan, senior vice president of pharmacy for Ahold USA. "There is no mandate that says MTM reimbursement has to come to retailers, but, yes, we could be reimbursed. In a nutshell it is still very much up in the air."
Pharmacies are currently reimbursed from a products sold standpoint rather than a services rendered standpoint, said Laurie Gethin, senior manager, pharmacy services, Food Marketing Institute, Washington. "This move to services is a paradigm shift that is hard to make, but it is encouraging that the government is allowing for it," she said.
MTM signifies the possibility of a changing role for pharmacists.
"Community pharmacists are either going to be respected health care professionals, worthy of reimbursement for our knowledge, or else we are purveyors of a product only, and only reimbursed for distribution of that product," said Verne Mounts, director of pharmacy for Buehler Food Markets, Wooster, Ohio.
Retailers, then, are in the midst of preparing to administer an in-depth service that might not result in additional income. "If we prepare by administering MTM now, and eventually parameters are put into place saying that we won't be reimbursed, how can we stop providing something to our customers that we were providing them before?" Fegan said.
The opportunity is large enough that retail pharmacies should prepare for MTM, even though the government payoff may not immediately follow, industry experts told SN.
"Right now we are telling retailers not to expect a lot of MTM business out of the Medicare Part D benefit," said Doug Lobdell, director, chain relations and business development, American Pharmacists Association, Washington. "The Centers for Medicare and Medicaid Services will probably take a look at MTM in 18 months and see what is being provided. At that time, however, we will need to be demonstrating that pharmacy-based services are more effective than anything else out there to keep it in place," he said.
CMS will be watching to see if pharmacists take advantage of this new opportunity, Mounts said.
"When the results of MTM in Medicare Part D become known, other health care payors and consumers are going to demand it as well," said Ken Dickson, director of managed care for Supervalu Pharmacies, Chanhassen, Minn.
Some experts have said that CMS will not implement MTM until the end of the first quarter of 2006, sources told SN.
"Right now we just have to jump in and get our feet wet," Beckner said. "From a simplistic standpoint retail pharmacy has been administering basic counseling and education for a long time. This is an opportunity to reach out and try to ensure a large segment of our customers are managing their medication appropriately," he said.
Ukrop's is about to launch MTM pilots in a few stores to gear up for the January launch of Part D, Beckner told SN. "We're calling the pilot service a 'medication checkup,"' he said.
The pharmacist performing this pilot service will sit down with patients to review their medications. "If, for instance, there are medications that might be eliminated, the pharmacist will call the patient's doctor and make a recommendation," Beckner said.
Having employees willing and able to give these services will be the challenge, Milovich said. "We must undertake an aggressive training campaign within our own organization to discuss what all of this means to the patients that we serve and to our company itself."
Twenty to 30 minutes is the estimated time for an MTM consultation, according to retailers and industry associations. "The only way to be able to provide MTM over the long haul with such a dedicated time obligation is to be paid for it," Beckner said.
At the least, retailers need to prepare the pharmacy for MTM, said Christopher Thomsen, president of the ThomsenGroup, a pharmacy and medical technology automation research and consultation company based in Kansas City, Mo. "Pharmacies need to take time to standardize their process to track and manage with efficiency, freeing the pharmacist to be up front," he said.
The current pharmacy model will need to be revamped at most retail sites, Mounts said. A pharmacy system that includes the management of workflow is imperative to separate the pharmacists from the distribution function and allow them to concentrate on MTM, he said.
Collaborative care arrangements with area physicians and local colleges of pharmacy are being pursued by Supervalu, Dickson said. "The importance of learning how to market our services and finding good partners in this area cannot be understated."
"We must first target the patients most in need," Milovich said. For Bashas', some examples of these would be patients seeing more than one doctor, with chronic disease states, or newly diagnosed with a debilitating condition.
Buehler Food Markets demonstrated its commitment to customer wellness earlier this year through a collaboration with the Ashland Area Chamber of Commerce in Ashland, Ohio, along with Ashland Business Development to hold an Affordable Healthcare Summit, Mounts told SN.
The summit incorporated presentations on the positive and cost-effective aspects of pharmacy-run MTM, he said. "The goal was to educate employers, create a need for MTM in the marketplace in addition to Medicare, and allow pharmacists and the health care community to satisfy that need."
At this point, Mounts said, only one plan sponsor, Community Care Rx, which was created by the National Community Pharmacists Association, Alexandria, Va., has offered reimbursable MTM to pharmacists as a part of their Part D approved prescription drug benefit.
"Our system is focused on community retail pharmacy with MTM, and putting the patient face to face with the pharmacist," said Kurt Proctor, chief operating officer of Community Care Rx.
Medication Therapy Management requires a patient and pharmacist to openly discuss every aspect of a patient's medication.
This service requires a private or semi-private area where the patient's privacy is safeguarded.
"Having the appropriate space makes Medication Therapy Management a challenge," said Christopher Thomsen, president of the ThomsenGroup, a pharmacy and medical technology automation research and consultation company based in Kansas City, Mo. "Retailers must offer a space where a patient can feel comfortable revealing medication, but some place that is not too far from the pharmacy."
This service isn't too much of a stretch for Ukrop's Super Markets, Richmond, Va., which has "Wellness Centers" in its stores. "We have an area next to the pharmacy for immunizations, screenings such as diabetes, and various educational programs," said John Beckner, director of pharmacy and health services.
These same wellness areas will be used for the more extensive medication therapy program.
At Buehler's Food Markets, Wooster, Ohio, a private area with the appropriate counseling resources will enable pharmacists to "provide MTM services in a professional and meaningful way," said Verne Mounts, director of pharmacy.
A semi-private area, at minimum, is a requirement of the MTM standards that have been set, said Dan Milovich, district pharmacy manager for Bashas' Markets, Chandler Ariz. "The majority of our stores now have semi-private to private counseling areas. So for us, I do not see space as an issue." -- WENDY TOTH
The Therapy Forefront
Supermarket pharmacies are well-positioned to offer medication management to customers, according to retailers.
Supermarket pharmacies see their patients in the stores more often than the typical drug store, said Dan Milovich, district pharmacy manager, Bashas', Chandler, Ariz. "The relationship that is built between the pharmacist and the patient is a much stronger one, which in turn will allow the supermarket pharmacist more of an opportunity in this area," he said.
"Loyalty is huge for the supermarket business," said Doug Lobdell, director, chain relations and business development, American Pharmacists Association, Washington. "A customer who comes to a supermarket pharmacy for MTM is more likely to come into the store for other business."
While offering MTM is of no more importance to supermarket pharmacies than any other pharmacy channel, "we have more of an opportunity in the supermarket pharmacy environment," said John Fegan, senior vice president of pharmacy for Ahold USA, Braintree, Mass.
"The opportunity is not only to answer questions that help manage our customers' medicine, but we have a nutritional element around us to tie in with overall health issues," Fegan said.
The public has become increasingly aware of everything they put into their bodies, said Ken Dickson, director of managed care for Supervalu Pharmacies, Chanhassen, Minn. "Supermarket pharmacies have the chance to see the entire market basket and factor that information into patient care," he said. -- WENDY TOTH