Community pharmacy-based medication therapy management services: financial impact for patients
Objective: To determine the direct financial impact for patients resulting from Medication Therapy Management (MTM) interventions made by community pharmacists. Secondary objectives include evaluating the patient and physician acceptance rates of the community pharmacists’ recommended MTM interventions.
Methods: This was a retrospective observational study conducted at 20 Price Chopper and Hen House grocery store chain pharmacies in the Kansas City metro area from January 1, 2010 to December 31, 2010. Study patients were Medicare Part D beneficiaries eligible for MTM services. The primary outcome was the change in patient out-of-pocket prescription medication expense as a result of MTM services.
Results: Of 128 patients included in this study, 68% experienced no out-of-pocket financial impact on their medication expenses as a result of MTM services. A total of 27% of the patients realized a cost-savings (USD440.50 per year, (SD=289.69)) while another 5% of patients saw a cost increase in out-of-pocket expense (USD255.66 per year, (SD=324.48)). The net financial impact for all 128 patients who participated in MTM services was an average savings of USD102.83 per patient per year (SD=269.18, p<0.0001). Pharmacists attempted a total of 732 recommendations; 391 (53%) were accepted by both the patient and their prescriber. A total of 341 (47%) recommendations were not accepted because of patient refusal (290, 85%) or prescriber refusal (51, 15%).
Conclusions: Patient participation in MTM services reduces patient out-of-pocket medication expense. However, this savings is driven by only 32% of subjects who are experiencing a financial impact on out-of-pocket medication expense. Additionally, the majority of the pharmacists’ recommended interventions (53%) were accepted by patients and prescribers.
2. Prescription Drug Benefit Manual Chapter 7 – Medication Therapy Management and Quality Improvement Program accessed at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/downloads/Chapter7.pdf, May 16, 2012.
3. Federal Register Vol. 70, No. 18 accessed at http://www.gpo.gov/fdsys/pkg/FR-2005-01-28/pdf/05-1321.pdf, May 16, 2012.
4. Bluml BM. Definition of medication therapy management: development of professionwide consensus. J Am Pharm Assoc. 2005;45(5):566-572.
5. American Pharmacists Association and National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: Core elements of an MTM service model (version 2.0). J Am Pharm Assoc. 2008;48(3):341-353.
6. Johannigman MJ, Leifheit M, Bellman N, Pierce T, Marriott A, Bishop C. Medication therapy management and condition care services in a community–based employer setting. Am J Health-Syst Pharm. 2010;67(16):1362-1367.
7. Bunting BA, Cranor CW. The Asheville Project: Long-term clinical, humanistic, and economic outcomes of a community-based medication therapy management program for asthma. J Am Pharm Assoc. 2006;46(2):133-147.
8. Planas LG, Crosby KM, Mitchell KD, Farmer KC. Evaluation of a hypertension medication therapy management program in patients with diabetes. J Am Pharm Assoc. 2009;49(2):164-170.
9. Ramalho de Oliveira D, Brummel AR, Miller DB. Medication Therapy Management: 10 years of experience in a large integrated health care system. J Manag Care Pharm. 2010;16(3):185-195.
10. McDonough RP, Harthan AA, McLeese KE, Doucette WR. Retrospective financial analysis of medication therapy management services from the pharmacy’s perspective. J Am Pharm Assoc. 2010;50(1):62-66.
11. Winston S, Lin YS. Impact on drug cost and use of Medicare Part D of medication therapy management services delivered in 2007. J Am Pharm Assoc. 2009;49(6):813-820.
12. DeName B, Divine H, Nicholas A, Steinke DT, Johnson CL. Identification of medication-related problems and health care provider acceptance of pharmacist recommendations in the DiabetesCARE program. J Am Pharm Assoc. 2008;48(6):731-736.
13. Doucette WR, McDounough RP, Klepser D, McCarthy R. Comprehensive medication therapy management: Identifying and resolving drug-related issues in a community pharmacy. Clin Ther. 2005;27(7):1104-1111.
14. Johannigman MJ, Leifheit M, Bellman N, Pierce T, Marriott A, Bishop C. Medication therapy management and condition care services in a community-based employer setting. Am J Health-Syst Pharm. 2010;67(16):1362-1367.
15. Li R, Zhang P, Barker LE, Chowdhury FM, Xuanping Z. Cost-effectiveness of interventions to prevent and control diabetes mellitus: A systematic review. Diabetes Care. 2010;33(8):1872-1894.