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    The future of pharmacy is finally here

    I’m not talking about “chickenization.” That was last month. [Editor's note: See "A pharmacy business model to squawk about," April 10, 2016.]

    The subject today is what pharmacy's "big thinkers" have told us we'd soon not be doing — counting, pouring, licking, and sticking — and what we've been promised we'd be spending our time on ever since some Southern governor named Clinton was running for president and Nirvana was the hot new band ruling the pop charts: optimizing drug therapy to maximize patient outcomes.

    Twelve years ago the pharmacy profession finally coalesced around a name and definition for a bright new future: medication therapy management, or MTM, the provision of services that include medication therapy reviews, pharmacotherapy consults, and all that other clinical stuff.

    See also: Let's do the time warp again

    No, we won’t accept your Rx

    Under that definition, what I spent a good chunk of my afternoon on the other day would certainly qualify as MTM, although maybe on a more basic level. It started with a call to an insurance company help desk.

    See also: Hold the phone

    “Yes, I'm getting a rejection for this doxycycline prescription. It must be some sort of mistake. It says you allow a maximum of one tablet per day.”

    “That's correct.”

    “Um, but the normal adult dose is two a day. And that's exactly how this prescription is written.”

    It had taken a good five minutes on hold before I got this far, during which I managed to work in some good old-fashioned counting, pouring, licking, and sticking so that I could make some money.

    “That dose would require a prior authorization.”

    “It's the normal dose! It would make more sense for you to intervene if I were submitting a claim for only once a day!”


    “Is there maybe someone else I could talk to?”

    Back on hold. You know that default hold music that comes with so many phone systems these days? I know you'd recognize it if I could play a few seconds of it here. I'm now afraid I'll be hearing it in my head nonstop for the rest of my life.

    No, we won’t transfer you

    I kept the revenue flowing by getting some prescriptions out the door, a little more slowly than usual, as I had to keep an ear tuned to the speaker phone. Finally, a voice came on the line.

    “Sir, you'll have to speak to the prior auth department.”

    “Can you transfer me?”

    “I can give you their number.”

    It was then that I began to suspect that MTM actually stood for “May Take Millennia,” but I guess no one had ever promised me that a future of optimizing drug therapy would be easy.

    David Stanley, RPh
    David Stanley is a pharmacy owner, blogger, and professional writer in northern California. Contact him at [email protected]


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