Drug benefit programs are involving community pharmacists with increasing frequency in services to improve patient safety, medication compliance, and health status.

The Medicare Modernization Act (MMA) spawned the evolution of a range of medication therapy management (MTM) programs that employ pharmacist-patient consultations to improve drug therapy and eliminate polypharmacy. MMA mandated MTM services to help targeted Medicare Part D beneficiaries. Now pharmacy benefit managers and managed care organizations are beginning to extend the services to commercially insured populations.

The success of the Asheville Project has perpetuated a collaborative patient care model that gives community pharmacists a leadership role in helping patients manage chronic conditions and improve health status. More than 100 employers nationwide have implemented HealthMapRx, developed by the American Pharmacists Association (APhA) Foundation, as a next generation Asheville model.

High-touch Programs Yield Results
Studies show that high-touch, pharmacist-coordinated programs deliver positive clinical and economic results.

The Journal of the American Pharmacists Association, March/April 2008, published results of a Minnesota MTM project that delivered a 12:1 return on investment. Fairview Health Services, Blue Cross and Blue Shield of Minnesota, and the University of Minnesota collaborated on the one-year study in which Fairview’s pharmacists provided face-to-face MTM services to 285 patients.

After receiving MTM services, patients met 90 percent of their goals of therapy, up from 76 percent previously. On HEDIS measures, a higher percentage of intervention patients met hypertension and cholesterol management goals than did patients in a comparison group. Total annual health expenditures for MTM patients decreased from $11,965 to $8,197 per person.

In another study, Walgreens Health Initiatives reported a drug cost savings of $52 per member per month (PMPM) for Medicare Part D beneficiaries as a result of first-year MTM polypharmacy interventions. The return-on-investment for payers was 2.5:1.

A 2008 outcomes report on first-year patient participation in the Diabetes Ten City Challenge showed measurable improvement in clinical indicators of diabetes management. Mean scores for glycosylated hemoglobin (A1C), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure decreased; and incidence of influenza vaccination, eye exams, and foot exams increased.

In this multi-city initiative, 29 employers at 10 distinct geographic sites contract for patient care services with community pharmacists using the HealthMapRx model. While the value of pharmacist involvement in clinical care is becoming more apparent, there are challenges to integrating hands-on care by pharmacists into drug benefit programs. PBMI research with pharmacy benefit stakeholders identified these hurdles:

• Evidence and data to support clinical and economic return on investment (ROI),
  
• Supply of trained pharmacists,
• Physical locations and facilities to conduct patient consults, and
• Infrastructure to document patient information and billing.

Recent Developments Address Challenges
The American Medical Association (AMA) has granted permanent approval to three Current Procedural Terminology (CPT) codes for pharmacists to use to bill third-party payers for face-to-face medication therapy management services (MTMS). Permanent code numbers became effective January 1, 2008.

Various organizations have developed certification programs to help pharmacists build the knowledge and skill needed to deliver quality MTM services. One such program, developed collaboratively by the APhA and the American Society of Consultant Pharmacists, is approved for credit by the Accreditation Council for Pharmacy Education (ACPE). Launched in 2007, the convenient self-study and interactive CD-ROM training program can be accessed at www.pharmacist.com under Education.

Some pharmacy colleges have developed MTM training programs for community pharmacists and pharmacy students. For example, pharmacists from the University of Arizona College of Pharmacy traveled to 16 cities nationwide in 2007 to train more than 450 pharmacists in patient counseling practices.

Study Tests Web-based Consultation
Although the prevailing perception is that face-to-face consultations drive improved outcomes, it’s not proven yet by comparison studies with other modes of interaction. A study published in the Journal of the American Medical Association, June 25, 2008, shows successful use of secure Web-based communications for patient consultations. In a trial involving 778 patients with uncontrolled hypertension, pharmacist care delivered via secure Web communications improved blood pressure control.

Additional studies may find that alternative methods of pharmacist-patient communication produce desirable clinical and economic outcomes when face-to-face communication is not possible.