Key Points
- Pharmacists can increase patient access to clinical services, resulting in better patient care and reduced costs.
- Pharmacist-led MTM programs also have been shown to reduce drug errors and improve patient outcomes.
- ASHP reviewed 11 successful MTM programs in 9 states that recognize pharmacists as providers and pay them for their clinical
services.
- While details vary, most such programs use CPT codes for billing, were created with the help of pharmacy faculty, and were
codified under state statutes.
- To become involved in your state, contact its offices of health, human services, or aging, and also your state Medicaid office.
A pharmacist-led medication therapy management (MTM) program in Minnesota resolved almost 800 drug-therapy problems in the
first year it was implemented, and pharmacists were paid $39,866 to provide these MTM services.
Called the Medication Therapy Management Care Program, the initiative serves recipients of Medicaid and General Assistance
Medical Care, a state program for low-income adults 21 to 64 years of age, who have no dependent children under the age of
18 and do not qualify for federal healthcare programs.
According to Lisa Diagle, policy analyst for the American Society of Health-System Pharmacists (ASHP), state health programs
like the one run by pharmacists in Minnesota have several advantages.
"There are opportunities for pharmacists to increase patient access to their clinical services through state health programs
that will improve patients' care and reduce healthcare costs. The programs identified by ASHP recognize pharmacists as providers
and pay them for their clinical services, which may eventually lead to universal provider recognition," she said. ASHP reviewed 11 programs in 9 states (Florida, Iowa, Minnesota, Mississippi, Montana, North Carolina, Ohio, Vermont, and
Wyoming), all centered on ways state MTM programs tap into pharmacists' clinical skills to improve patient outcomes. Through
these programs, pharmacists have demonstrated their ability to deliver MTM services. Although these programs took various
approaches to management, billing, and eligibility, they shared some key characteristics:
- Most are pharmacist-based;
- Most rely on Current Procedural Terminology (CPT) codes or a system based on CPT codes for billing;
- Most were created with the active involvement of the faculty of a school of pharmacy;
- Most were codified under state statues, usually through an appropriations bill.
"State health programs that utilize pharmacists to provide MTM services are key to resolving patients' drug-therapy problems
and reducing healthcare expenditures," ASHP's Diagle said.
"For example, in the first year of Minnesota's Medication Therapy Management Care program, 34 pharmacists provided MTM services
to 259 patients and resolved 789 drug therapy problems, 3.1 per patient. Many of the programs ASHP identified were using pharmacists
to help manage drug therapy for patients with multiple chronic conditions who take multiple medications."
She added, "As the medication experts, pharmacists are uniquely suited for this role."
Iowa's Pharmaceutical Case Management program is another example of a successful state MTM program. In all, Iowa pharmacists
met with 943 patients, sent recommendations to physicians for 500 of them, and detected an average of 2.6 medication-related
problems per patient. Pharmacists recommended new medications in 52 percent of these patients. Data showed that during the
fiscal years 2002 through 2005, $254,797 was paid for pharmaceutical case management, with $241,784 paid to pharmacists.
Getting involved
To become involved in such programs, Diagle suggests pharmacists contact their state departments or offices that provide healthcare
programs, including their state's department of health, human services, or aging. In addition, she said, most of the programs
identified by ASHP provide services for Medicaid patients, so contacting the state's Medicaid office would also be helpful.
"If a similar program does not exist in the pharmacist's state, he or she can talk with peers and with the state's pharmacist
organization to see if there is interest in creating such a program. Once interest in creating a program is established, faculty
from the state's school of pharmacy should be engaged, as should state legislators," Diagle said.
Pharmacists looking to learn more about the MTM services provided in state health programs can learn more by accessing ASHP's
policy analysis paper on this topic at http://www.ashp.org/.
Campaign 2011: MTM for the elderly
The American Society of Consultant Pharmacists (ASCP) has rolled out a multifaceted initiative program known as Campaign 2011.
The program is designed to:
- Raise awareness in the elderly of the prevalence and availability of medication-related programs.
- Advance appropriate, effective, and safe use of medications by the elderly, by promoting the benefits of pharmacist-led MTM.
- Increase the number of pharmacists with expertise in managing the special pharmaceutical needs of elderly patients.
Claudia Schlosberg, JD, ASCP's director of policy and advocacy, explained that Campaign 2011 was conceived "to raise awareness
that medications, while incredibly important, are also the cause of many problems. In our country, we spend a lot of money
on medications, but we also spend an almost equal amount in resolving the problems caused by medications. ASCP wants to raise
awareness because pharmacists play an important role in addressing these problems."
Pharmacists' clinical knowledge is not widely known, Schlosberg added. "People really don't understand what pharmacists do
or the level of education that they have. Pharmacists are the medication experts. Ten years ago, the Institute of Medicine
talked about utilizing pharmacist expertise in our healthcare system, but we're really not doing that."
ASCP is a 40-year-old professional association representing approximately 7,000 pharmacists who specialize in providing clinical
geriatric care. "Our passion is promoting the appropriate, safe, and effective use of medications in the elderly," Schlosberg
said.
In connection with safety, ASCP has noted that up to 24 percent of drug use by seniors may be inappropriate or unnecessary,
and thousands of seniors suffer from medication-related problems each year, with the annual cost of treatment exceeding $200
billion.
ASCP rolled out Campaign 2011 during its annual meeting in New Orleans in November 2008. Working through state chapters and
several workshop sites in Florida and Washington, ASCP will use Campaign 2011 to pursue leadership initiatives, strengthen
grassroots advocacy, advance a legislative platform, and push for improved senior care and increased availability of MTM.
The year 2011 refers to the year the first baby boomers turn 65 and become eligible for Medicare, Schlosberg said, adding
that in the next 20 to 30 years, the number of individuals age 65 and over is expected to double.
Pharmacists are the solution
ASCP hopes Campaign 2011 will make the public aware of both the problem and its solution.
"Pharmacists are uniquely positioned to ensure the safe, effective, and appropriate use of medication by older adults," Schlosberg
said. "Pharmacists are the medication experts. I don't think people realize that many pharmacists have a focus on clinical
assessment and evaluation of medication use and the medication process. The Institute of Medicine said it best: 'Because of
the immense variety and complexity of medications now available, it's impossible for nurses and physicians to keep up with
all the information required for safe medication use.
"The pharmacist has become an essential resource, and access to his or her expertise must be made possible at all times,'"
she said.
"There is no other healthcare professional who spends as much time and is as focused on medications as the pharmacist."
Liz Meszaros is a freelance writer in eastern Pa.
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