WHAT IT MEANS AND WHY IT’S IMPORTANT For the second year in a row, Raleigh, N.C.-based Kerr Drug has earned high marks from a major health provider network for its ability to deliver effective medication therapy management to its patients. Considering that MTM is critical to the future of pharmacy as a real, patient-centered healthcare profession instead of merely a dispenser of medications, Kerr’s efforts — and recognition by Outcomes Pharmaceutical Health Care for those efforts — are a timely step in the right direction.
(THE NEWS: Kerr Drug honored for MTM services. For the full story, click here)
The fact that this 100-store healthcare innovator has emerged as one of the leaders in MTM delivery is no real surprise: Kerr has staked its future on advancing new concepts in community-oriented, accessible and integrated health care. More than most pharmacy retailers, it has turned its drug store network in North and South Carolina into a platform for a whole suite of clinical health-and-wellness services, and its mission is to turn those services into a viable, profitable retail business and an alternative to high-cost, traditional healthcare models.
To work, though, Kerr’s efforts will need to be replicated in every region of the country. Nearly seven years after the concept of medication therapy management was enshrined into law as one of the pillars of a more patient-friendly, productive and cost-effective healthcare system, it remains a maddening chicken-and-egg conundrum for many chain and independent pharmacy providers.
It isn’t hard to see why. It’s daunting for any pharmacy retailer to mount an effective, large-scale MTM program for patients when guarantees of adequate payment for the service from public or private insurers remain spotty at best — particularly when there’s no uniform, national standard for payment. And insurers are notoriously reluctant to spend money on preventive-care and patient-intervention programs that don’t provide a specific cost-benefit ratio or a proven return on investment.
This, despite the fact that numerous MTM pilot programs around the country have churned up a growing body of evidence that pharmacy-provided MTM services save plan payers real dollars. When pharmacists help patients understand the role their medicines play and the value of complying with their drug therapy — and also help monitor their progress through that therapy — both patients and payers benefit.
Just to clear the air, let’s go back and define the MTM concept. The National Association of Chain Drug Stores mounts as good a definition as any we’ve heard: “Medication Therapy Management,” the group reminded Congress last year, “is a proven set of services that optimize medication use, enhance communication between providers and patients and enable patients to be more actively involved in medication self-management.”
From the beginning of the health-reform debate in Congress, expanding the role of MTM in the U.S. healthcare system — and particularly in federal prescription benefit programs like Medicare Part D — has been one of three key priorities for both chain and independent pharmacy lobbyists. In one letter to Senate and House leaders last year, NACDS pointed out that “Congress recognized the value of MTM when it required Part D plans to offer the services under the Medicare Modernization Act of 2003.”
What’s more: NACDS told Senate majority leader Harry Reid and House Speaker Nancy Pelosi, “several state Medicaid programs include MTM in their pharmacy programs and private employers are utilizing the services as well, due to their success in reducing costs and improving health outcomes.”
Indeed, wrote NACDS president and CEO Steve Anderson, “The need for MTM could not be clearer. Approximately 70% of all primary care office visits result in a prescription being written, but unfortunately, the benefits of these important therapies are not fully realized due to poor adherence, compliance and drug interactions.
“In fact, failure of patients to properly take medications costs this country over $177 billion annually,” Anderson added.
For pharmacist-delivered MTM to gain universal recognition for its role in improving patient outcomes and saving health costs, however, will probably require a clearer set of guidelines from Congress and the White House, presumably through the Dept. of Health and Human Services. Those guidelines should specifically designate pharmacists as most qualified and best positioned to deliver MTM, and they should lay out specific standards for reimbursement through programs like Medicare Part D, Medicaid and the TRICARE military health program.
Meanwhile, pharmacy retailers like Kerr Drug continue to pile up evidence of the program’s benefits, both to patients and health plan sponsors who are saving millions of dollars in long-term health costs. Let’s hope the federal government and the nation’s employer-based health plans are listening.