MTMS in Medicare: Critical to the Future of Pharmacy

How long have you been apharmacist? The chances aregood, no matter how long ithas been, that you have heard plentyabout payment for nondispensingpharmacy services. Unfortunately, thechances also are good that you haveseen little evidence of such payments.That situation may soon change.

By now, it is well known that theMedicare Modernization Act (MMA)of 2003, which goes into effect fully inJanuary 2006, will cover prescriptionmedications for Medicare beneficiaries.The MMA, however, calls foranother critical Medicare service:Medication Therapy ManagementServices (MTMS). Beginning in 2006,the nation's largest payer of healthcare services, the US government, willpay for the medication managementservices of potentially millions of eligibleMedicare beneficiaries. What an opportunityfor payment for nondispensingservices!

What exactly is MTMS? As a pharmacist,you may have a very clear ideaof what such a service entails. After all,you do it every day. Unfortunately,however, there is no clear, widelyaccepted definition of this term in ourhealth care system. Pharmacy is workinghard to establish such a definitionand, importantly, to make the pharmacistthe primary provider of thisservice. In July 2004, the profession ofpharmacy took a big step forward inhelping to define MTMS. Convenedby the American Pharmacists Association,11 national pharmacy organizationshammered out a 1-page definitionof MTMS (see Pharmacy Times,January 2005, page 72, or visitwww.aphanet.org). We have beenusing that definition to communicateour vision of MTMS to others outsideof pharmacy, such as the Centers forMedicare and Medicaid Services, thefederal agency responsible for administeringthe Medicare MTMS benefit.

Will pharmacists provide Medicare'sMTMS? The answer is up to us. Theregulations governing the MMA,including those for MTMS, have justappeared. In those regulations, pharmacistsare mentioned as possibleMTMS providers, but the services arenot being handed exclusively to us.Between now and 2006, many healthcare providers and health care organizationsalso will be looking to becomeMTMS providers.

In an age of Internet pharmacies,mandatory mail-order pharmacy services,and illegal importation of prescriptionmedications from Canadaand other foreign countries, it is moreimportant than ever for pharmacists todemonstrate their value to the healthcare system. Providing effective MTMSrepresents a critical opportunity for ourprofession. Pharmacists are the idealhealth care providers for MTMS. Let usstep up and demonstrate that fact to allof health care. We will need the supportof every pharmacist!

Mr. Staffa is vice president of pharmacypractice and communications at the NationalAssociation of Chain Drug Stores.