Putting some teeth into MTM

Message to Congress: You’ve got to spend a little money to save a lot of it. Paying $100 million to the nation’s community pharmacists to provide comprehensive medication therapy management to more American seniors would save Medicare $1 billion or more. Spend $200 million and save $2 billion ... you get the picture.

It’s time for the feds to take the larger view of pharmacy-driven preventive health costs and benefits and put some teeth into drug therapy management for older Americans. The concept of MTM services delivered by pharmacists was woven into the Medicare Modernization Act that created the Medicare Part D prescription drug benefit program, but it’s been limited to seniors with multiple chronic conditions, and its language was vague regarding such things as frequency of seniors’ drug utilization reviews, measurement of patients’ long-term outcomes with MTM and standardized payments for pharmacists.

Two members of Congress have been trying for the past year to fix those shortcomings through a piece of legislation called the Medication Therapy Management Benefits Act. The bipartisan bill, introduced last year by Reps. Mike Ross, D-Ala., and Cathy McMorris Rodgers, R-Wash., would allow Part D beneficiaries access to pharmacist-delivered MTM, even if they have only one chronic condition. It also would provide funds for creation of a personal medication record and quarterly, face-to-face medication reviews by a licensed pharmacist.

(For a description of the bill, go to the Library of Congress).

In a written appeal for support and co-sponsorships for their bill, Ross and Rodgers told their congressional colleagues that every dollar spent on MTM saves $10 or more in avoided healthcare costs (see Reps. seek sponsors for MTM bill). "There is significant evidence that MTM improves care and saves money," the two wrote in late January.

An independent audit of North Carolina’s ChecKmeds NC program — a five-year-old MTM initiative open to all senior residents of the state who are members of a Medicare Part D drug benefit plan — turned up an even more striking result. According to Mark Gregory, VP pharmacy and government relations for Raleigh, N.C.-based Kerr Drug, that outside survey found that for every dollar invested in MTM provided by pharmacists through the ChecKmeds NC program, Medicare saved an average of $13.55 in reduced hospitalizations and other acute care costs for seniors.

That’s saving North Carolina’s Medicare program $34 million each year, Ross and Rodgers told Congress.

Another study of 186 patients covered by Blue Cross/Blue Shield of Minnesota found that the steady intervention of pharmacists with patients through a regularly applied MTM program cut those patients’ health costs 31.5%, or $12.15 per dollar invested in MTM services.

The long and short of it: Pharmacists potentially can save the nation’s overwrought, stretched-thin healthcare system huge amounts of money by working with patients to identify potential medication problems, improve their adherence to their drug regimens and monitor their progress.

"The drug distribution system is broken and fragmented,” Gregory told Pharmacist Society in mid-February. “One element of drug distribution we need is comprehensive medication management. And of course, pharmacy needs to get reimbursed for those services. Having an outcomes-based pharmaceutical model that can measure results gives you documentation that almost guarantees a savings. If you measure it, there’s significant value to it, and that’s what we’re doing now: measuring it.”