Pharmacists are among the most visible health care providers in the country today, as any visit to a local pharmacy will attest. But the days of being relegated solely to filling prescriptions behind the counter are long over. Pharmacists today perform many crucial care duties outside of the traditional pharmacy.
Nowhere is this more evident than in the practice of overseeing and managing the utilization of millions of medications received by individuals covered by a pharmacy benefit.
Health plans, PBMs, and other managed care organizations rely on pharmacists to conduct medication therapy management (MTM) and drug utilization reviews (DUR) for the populations they serve. Such managed care activities are designed to both improve health outcomes and lower costs.
Managed care pharmacy, in fact, has become a crucial component in an era of soaring drug costs, high pharmaceutical utilization, and an overburdened health care and pharmacy sector.
The challenges of todays’ complex health care system are well documented:
Unfortunately, in many cases, patients and payers have been left with less than optimal results. This doesn’t have to be the case, as studies have found MTM and other management programs to be effective.
MTM: Optimizing Medication Use
Medication Therapy Management (MTM) has been practiced under different names by pharmacists in commercial and government-run health programs for decades. It gained its current moniker through the 2003 Medicare Prescription Drug, Improvement, and Modernization Act, which required Medicare Part D plans to offer MTM services to eligible beneficiaries.
Under the law, MTM services are designed to address issues of polypharmacy, preventable adverse drug events, medication adherence, and medication misuse. In 2008, eleven national pharmacy organizations achieved a consensus framework for MTM services and established five core elements for the practice. MTM involves the completion of a:
Pharmacists achieve these goals often by using powerful electronic prescription records, which offer a complete prescription picture that can identify gaps in care along with problems, such as potential drug-drug interactions. MTM reviews also can identify opportunities to lower costs, including switches to generic drugs or less expensive but equally effective alternative brand products.
Professional organizations representing pharmacists in this setting are continually refining MTM practices. For example, pharmacists should emphasize coordination of care for the patient, including by integrating MTM programs along with disease management and medical management programs to result in better patient outcomes, the Academy of Managed Care Pharmacy (AMCP) advises in an MTM guidance.
A September 2020 study in the Journal of Managed Care and Specialty Pharmacy examined the clinical, economic, and humanistic outcomes of 10 years (1998 to 2008) of delivering MTM services to patients in Fairview Health Services, an integrated health care system with 48 primary care clinics. The MTM services were provided face-to-face to 9,068 patients, aged 21 years and older. Among the results over the 10-year period:
Different Types of DUR
Similar to MTM is the practice of drug utilization review. A DUR is an authorized and structured review of actions such as: practitioner prescribing, pharmacist dispensing, and patient use of medications, according to AMCP. The purpose of DUR is to ensure drugs are used appropriately, safely and effectively to improve patient health status.
Red flags that pharmacists might raise through this practice include drug-drug interactions. By having access to the full prescribing history, for example, a pharmacist could see that one physician had prescribed a patient warfarin to prevent blood clots. But another specialist had also prescribed a separate drug to treat arthritis. If taken together, the patient could experience internal bleeding.
Pharmacists conducting a DUR or other review would spot the danger and contact each prescriber to alert them of the problem.
Value Pharmacists Add to Health Care System
Pharmacists will always remain a white-coated fixture of the pharmacy, filling prescriptions and dispensing medications behind the counter.
But we know they can do so much more.
WithMe Health believes now is the time for pharmacists to take center stage and play a more active role in medication management. Technology, new data systems and a change in social norms provides the perfect opportunity for pharmacists to support members at every step of their medication journey.
All of this, of course, is supported by a new social context that demands transparency and adherence to evidence-based practices that focus solely on what’s best for the patient.
Pharmacists at WithMe are ideally situated to help members achieve the best clinical outcomes at the lowest possible cost. We achieve this by using known, evidence based, proven techniques (MTM, DUR etc.) along with technology to give pharmacists the role they deserve in quarterbacking medication management throughout the member journey.
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