Areas for improvement include business model, healthcare team buy-in, patient engagement and technology.
The Medicare Prescription, Drug, Improvement, and Modernixzation Act of 2003 established requirements under Part D to provide medication therapy management (MTM) services to eligible Medicare beneficiaries.1
This formed the basis for an expansion of the role of pharmacists in patient care. In 2018, about 65% of plans reported using community pharmacists through supplier contracts.2.3 However, there are challenges in implementing MTM services in community pharmacy workflow.
The results of a cross-sectional study of a random sample of enrollment data from Medicare beneficiaries evaluating 2014 Part D MTM files showed that community pharmacists provided more medication therapy recommendations (MTP) (P<.001), but dissolving fewer MTPs than those dispensed by non-Community pharmacists (e.g., MTM reseller home pharmacists, Medicare Part D plan pharmacists)2† Evidence shows that the following challenges are in implementing MTM services in community practice: business model obstacles, integration of programs into the healthcare team, integration into the pharmacy workflow, lack of patient involvement and problems with the technology adaptation (figure2-5†
Challenges in incorporating MTM services into the pharmacy workflow include difficulty in training staff, insufficient physical space to conduct consultations, and lack of time.2.3 Busy chain pharmacies can struggle to incorporate MTM services due to the many pharmacist responsibilities that include administering vaccinations and dispensing medications. There is some evidence that access to technology is critical for MTM services, especially for viewing electronic health records.3.4 Typically, MTM suppliers use web-based software for documentation and billing, so it is critical to involve trained pharmacy technicians in this task. The results of another study identified barriers and implementation strategies for the integration of a web-based medication management application in community pharmacies.4 In addition, the study results showed that clinical training, computer skills and leadership training enabled the implementation of a web-based program in practice.4 However, staff resistance to change and providers’ reluctance to share data were seen as barriers to the technology’s implementation.4
Lack of patient interest in MTM services is also an obstacle.3 In addition, many patients are not aware that the clinical training of pharmacists goes beyond dispensing medicines.3 Pharmacists can develop a standardized approach to delivering MTM services and explain their role to patients. Pharmacists and physicians can also successfully work together through collaborative drug therapy management to improve communication and patient care.3 The results of a third study showed that there was an increase in MTM completion rates after an educational intervention was implemented at community pharmacies (P<.001).5
According to the results of a report from Health2 Resources, according to the results of a report from Health2 Resources, more than 600 pharmacist practitioners and program directors who provided survey responses indicate that comprehensive drug management (CMM) services enable healthcare organizations to achieve clinician satisfaction, cost savings , achieve improved outcomes and patient satisfaction .6
The CMM approach focuses on clinical, patient and personal goals to improve health outcomes.6 Goodrich Pharmacy, an independent pharmacy in Anoka, Minnesota, and HealthPartners successfully conducted CMM.6 HealthPartners began paying for CMM services in 2006.6 At the time of writing, Goodrich Pharmacy employed 18 pharmacists in 7 locations and used CMM on approximately 900 patients.6
About the author
Jennifer German† PharmD† CPh† PACSis a drug information pharmacist and contributor to Pharmacy Times® who resides in South Florida.
1. Medicare Prescription Drug, Improvement, and Modernization Act of 2003, HR 1, 108th Cong (2003). Accessed April 7, 2022. https://www.congress.gov/bill/108th-congress/house-bill/1
2. Adeoye OA, Farley JF, Coe AB, et al. Drug therapy management by community pharmacists: insights from a national sample of Medicare Part D beneficiaries. J Am Coll Clin Pharm† 2019;2(4):373-382. doi:10.1002/jac5.1160
3. Ferreri SP, Hughes TD, Snyder ME. Drug therapy management : current challenges. Integr Pharm Res Pract† 2020;9:71-81. doi:10.2147/IPRP.S179628
4. Turner K, Renfro C, Ferreri S, Roberts K, Pfeiffenberger T, Shea CM. Support community pharmacies with the implementation of a web-based medication management application. App Clin Inform† 2018;9(2):391-402. doi:10.1055/s-0038-1651488
5. Hohmeier KC, Wheeler JS, Brookhart A, et al. Aiming for adaptability to improve drug therapy management (MTM) implementation in community pharmacy. Implementing science† 2019;14(1):99. doi:10.1186/s13012-019-0946-7
6. GTMRx Institute. The Get the Medications iight report: A nationwide snapshot of expert practice – comprehensive medication management in ambulatory/community pharmacies. May 2016. Accessed April 8, 2022. https://gtmr.org/the-gtmr-report/