MTM by non-pharmacists

[michekauf]

There seems to be a push for non-pharmacists to provide MTM. In a recent brief from the National Conference of State Legislatures (Medication Therapy Management: Health, Safety and Savings) they state that MTM under the MMA is to be provided by pharmacists and other qualified health care providers. Do you find that it is being done by the plans? PBMs? PDPs? or at the dispensing end by community pharmacists? Are there any case managers in health plans or other related settings providing this service? Is it being done right if not by pharmacists? Is this something that should be done by nurses? Physicians? someone else besides pharmacists? How do we as pharmacists feel about this? Should we collaborating more with members of the health-care team to provide this service to our Medicare Part D members? Who do we consider qualified besides pharmacists?
Any thoughts on this would be sincerely appreciated!

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[ewood]

Our view is that MTM is ideally delivered by pharmacists, specifically the one-on-one engagements and comprehensive medication reviews. When a patient is in case management, a nurse takes the lead on the engagement and the pharmacists serves as consultant to case management. In this model, the case manager is actually delivering the MTM service, supported by a pharmacist-consultant. Also, home visits by nurses or nurses aids can support MTM with important information regarding medication organization and aherence. MTM services should be designed and led by pharmacists, but other professionals can contribute and support appropriate medication use.

[chantell.reagan]

We received anonymous feedback from one of our members:

"I strongly believe that pharmacists are the best health care professionals to provide MEDICATION therapy management. Due to the additional requirements for 2010, there is a push towards having nurses, case managers etc.. do the job. DON'T LET THIS HAPPEN!!! The pharmacist knows more about medications, indications, dosage, drug interactions, side effects, drug-drug/drug-disease interactions than any other health professional. Furthermore, once we relinquish this opportunity to show our value as a health care partners, we will never get another chance!!! I am fighting to keep MTM in the pharmacy department in my health plan and everyone should do the same. Our profession's survival depends on how we will demonstrate our value. Here's our chance!"

[chantell.reagan]

We received anonymous feedback from one of our members:

"MTM can be supported by non-pharmacists in a manner that involves collection of information, however in most cases, only a Pharmacist will have the experience and knowledge to handle medication related problems. I am in favor of mandating pharmacist interventions."

[chantell.reagan]

We received anonymous feedback from one of our members:

"It is being performed in the field by Case Managers in conjunction with Pharmacists by several Medicare Advantage Plans. They are trying to prevent more Seniors from reaching the "Donut Hole" too soon in their coverage.
From what I have seen, they are not trying to file for reimbursement since it is their members they are counseling."

[cvs1966]

MTM needs to be performed by the PHARMACIST - one on one with the patient. Period. They are the most qualified and are in the best overall position for this important process.

[michekauf]

Does anyone have a protocol for MTM by the pharmacist, or if it is being done by other provider(s), a guideline? Seems like we need to develop something... like the pharmacy case management I tried to do in the health plan, but with the patient. Is this something that the "retail" or "specialty" pharmacist is doing or is there some better way? Please help and thanks for all your replies, keep them coming. -Michele

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[diana.papshev]

Anonymous member response:

"the primary question that needs to be addressed is why the 'pharmacy system' as a whole is not incorporated into MTM with or without HP involvement. That has been noticeably absent and is a large reason that there is not a firm platform for change in reimbursement for any pharmacy intervention. The second issue is whether a pharmacist is necessary to due the intervention personally. The answer to that is that most treatments are based on an algorithm that is easy follow and is evidence based. the drug interactions are readily available and their are copious tools to evaluate compliance, both adherence and persistence. There is no reason that non-pharmacist cannot review the whole picture and make recommendations with a pharmacist signing off on the intervention.
the third point is that pharmacy training has not traditionally been focused on outcomes driven wholistic interventions and to do this correctly, it may take a person with a more broad base of understanding or even a team approach to encapsulate the entire patient experience.
Just two cents to consider"

[diana.papshev]

Anonymous member response:

"More Health Plans are moving to using Case Managers who work with internal PharmDs in their plan to counsel members, especially for Medicare Advantage Plans. As long as there is collaboration, there shouldn't be any issues."

[diana.papshev]

Anonymous member response:

"Wisconsin Medicaid began paying for pharmaceutical care services (precursor to MTM) in 1996. The program was designed to use DUR coding for reason, action and result combined with level of care to determine reimbursement. Extensive protocols were developed to assist pharmacists. Abbreviated materials still exist on this link.

Participation is limited though the program continues."

[diana.papshev]

Anonymous member response:

"It is evident that a consistent approach to pharmacy care should yield the most optimal outcomes. Standardized patient assessments, reassessments, and education surveys with branched decision logic provide flexible but consistent approaches to pharmacy care. Scripting these patient interactions provides a guideline for health care professionals to follow and and a consistency to the information exchanged. Documentation of pharmacist interventions can also be standardized in a logical format. Finally, automating all these interactions for documentation and data capture purposes yields an incredibly rich record of teaching and care provided, interventions, patient response to therapy, and ultimately outcomes."