Healthcare reform efforts are still in the making. But so far, bills in the Senate and House of Representatives have clauses for medication therapy management (MTM) services, reports Anne Burns, vice president of professional affairs for the American Pharmacists Association (APhA). “We are excited that medication therapy management (MTM) services, including MTM services related to adherence, are included in different sections of the bills,” she says. “Grant programs for management of MTM services are provided for transitions of care, such as from hospital to home.”
For instance, the Affordable Health Care for America Act (H.R. 3962), sponsored by Congressman John Dingell (D-MI), “would establish a program to provide grants to eligible entities to implement MTM services provided by licensed pharmacists [for] the treatment of chronic diseases – such as heart disease, cancer and diabetes – for targeted individuals,” APhA reports. In addition, the bills would also cover a “medical home pilot program through which a primary care physician would coordinate patients’ health care services, such as pharmacist-provided medication therapy management services. Medication therapy management services are also included in programs to reduce preventable hospital readmissions by improving transitions of care, such as from hospital to home.”
Still, there is a lot of work to be done. “It is not clear what the final result will be,” Burns says. “Many of the current proposals lack specifics. Currently, there is not a good level of definition on the services or how they will be paid for.”
With MTM services emerging, there may be an opportunity for pharmaceutical manufacturers to play a role with special packaging. “There are multiple causes of nonadherence, some of which involve forgetfulness,” Burns explains. “Special packaging can be a beneficial tool to assist patients’ adherence.”
Pharmacists also need more information on what packaging technologies are available to include in their services for patients with adherence issues. “Pharmacists and packagers need to have an improved dialogue. Published studies on how the use of packaging impacts adherence, too, would help to educate pharmacists,” she says.
Burns notes that Medicare Part D has had a provision for MTM, but such services have been slow to emerge, and there has been significant variability in how the services are currently being delivered. “CMS is implementing substantial changes to the MTM service provisions in 2010 that should help to standardize MTM service delivery.”
One barrier to wider provision of MTM services remains the development of a viable business model for pharmacists, Burns notes.
In addition, a lot of what pharmacists choose to dispense depends upon what health plans cover or doctors prescribe.
Still, Burns is optimistic that “if we really move toward quality of healthcare, providers will be rewarded for providing quality services. If aligned incentives are in place, then pharmacists will have the time to work with doctors to improve medication use through medication therapy management services.”