A few key reasons:
1. Payers remain concerned about opening a "blank check" for cognitive services without understanding the value
2. Very difficult for pharmacies to alter prescription workflow to provide intensive management for just a few patients
3. Cumbersome process to get started including new training, contracting and billing requirements
I have tried the following process with limited success but still believe it is the best way to get pharmacists engaged in medication therapy management.
1. Use an alert engine to identify and notify the physicians about drug therapy issues (e.g., poor adherence)
2. Refer select high-risk alerts and those without a successful change in therapy to care managers; including pharmacists for medication therapy management (MTM)
3. Two options for paying pharmacists to manage medication therapy; a) pay the local pharmacist to address the care gap and document their intervention or b) contract with pharmacist MTM firms to intervene telephonically
This process helps control budget concerns by only paying for carefully identified, high risk drug therapy issues. It also eliminates the need for cumbersome training and contracting issues.
Here's a few highlights from the August 15th AJHP News article "Wyoming Pharmacist Consultation Program Ends, but Idea Survives Elsewhere" http://tinyurl.com/map5o7
Wyoming's program, recently cut, pays up to $120 for a one-time consultation but enrolled only 15-20 patients annually. Medicare Part D prescription drug benefit went into effect. Montana pays up to $125 and has 19 participating pharmacists but only four patients with a fully documented session. Colorado pays $75 per session but the article did not mention the number of participants. Though open to any state resident, part of the low participation relates to the introduction of Medicare Part D that lowered costs for patients over age 65. This reduces the demand for counseling focused on cost savings.
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