Punch & Judy: Breaking the vicious circle

How many times have you heard people say pharmacists don't counsel because they're not paid for it? But then payers argue that they don't pay because they haven't seen pharmacists provide the service.

This vicious circle probably isn't going to be broken any time soon by the medication therapy management (MTM) provisions of the Medicare Part D final rules, all 1,200-plus pages of which were released last month. I profess to be disappointed by the section dealing with MTM because it has left so many things up in the air.

Organized pharmacy had pinned such high hopes on MTM as a new opportunity for pharmacists to strut their stuff and be reimbursed for their clinical services. But the rules state that "insufficient standards and performance measures exist to support further specification" of MTM. The feds will leave it up to the health plans to specify their requirements for this service.

Can you imagine R.Ph.s applying this argument to wrest a decent reimbursement for MTM and getting away with it? No way. Even now, our pharmacy leaders have a hard enough time explaining what R.Ph. counseling is to lawmakers, let alone demanding a fee for it. As one pharmacy association executive recently remarked, lawmakers' typical reaction is, "What are you talking about? My pharmacist never counsels me."

It's easy for some pharmacy leaders to take the moral high ground and say that pharmacists should provide MTM regardless of whether or not they are paid for these services. But we all know that if there is no reimbursement, pharmacists won't spend the time providing these services. Heck, even when payment has been made available, many pharmacists have resisted providing DUR because they consider the rates too low or they didn't have time to offer it. We've seen this in Mississippi, Wisconsin, and other states where Medicaid has paid pharmacists for disease management, but only a minority of R.Ph.s have enrolled in these programs.

Will pharmacists take part in MTM in order to serve as preferred pharmacies when Medicare Part D kicks off next year? We'll just have to wait and see.

Meanwhile, in the absence of minimum MTM standards from the feds, Drug Topics sought to find out, through an Instant Poll on our Web site last month, which type of R.Ph.s should provide these services?

At press time, the answer that drew the most votes was R.Ph.s with additional training, followed closely by all of the above. Some 277 people responded to the poll.

Clearly many questions remain about MTM. To help you come to grips with this development, Drug Topics will be coming out with a cover story on this topic in our next issue. Keep an eye out for it.