INITIATIVE 2:Devise a Business Plan for Medication Therapy Management

Wendy Toth

In what retailers identified as a big victory, pharmacists were given permanent billing codes for reporting medication therapy management services in October. This gives an unofficial green light for MTM programs to supermarket pharmacies. Pharmacists can feel confident about receiving payment from insurers.

Called Current Procedural Terminology (CPT) codes, the nomenclature is used by the health care industry for reporting professional services rendered in health care claims.

“This change implies that pharmacists are being accepted as a larger partner in overall health care — and a valuable resource as a dispenser of education, not just pharmaceuticals,” said Dan Milovich, director of pharmacy operations at Bashas' Markets, Chandler, Ariz.

This is the first time pharmacy has ever been a part of CPT, said Stacey Swartz, director of management and educational affairs at the National Community Pharmacists Association, Alexandria, Va. The codes are included in the American Medical Association's “Current Procedural Terminology” manual for 2008, the association reported.

“This tells us that, yes, we are making a difference, and that our programs are gaining a high level of acceptance,” Milovich said.

Temporary codes were assigned by the AMA in 2005. “Since then, AMA has recognized that this is a business need. Now pharmacies will have a way to bill for MTM, making it easier for payors to add it into their systems as part of a benefits package,” Swartz said.

According to the billing coding, MTM includes the following documented elements: review of pertinent patient history, medication profile, and recommendations for improving health outcomes and treatment compliance.

With this ability comes the need for pharmacies to develop their MTM programs in a way that will work for their business, retailers said.

Verne Mounts, director of pharmacy for Buehler Food Markets, Wooster, Ohio, said the codes will make it easier both for health care plans to cover MTM and for pharmacies to offer it. “We'd like to include MTM in the current health care plan for our own employees, as well as add counseling rooms to all of our stores in which to perform it.”

Outside of making space in the pharmacy and scheduling times for the services, retailers need to find proper technology for billing, scheduling and record-keeping, Milovich said. “From a technology standpoint, we just need to be certain that our pharmacy platform vendors step up to the plate and integrate the proper programs into their software to allow us to accomplish what needs to be done. The consumer will be rewarded with a continuum of health care and an overall better quality of patient care.”