Minding the Medications

Medication Therapy Management benefits patients who use multiple drugs--and may reduce the cost of health care, too.

By Joel Hoekstra

Most pharmacists are rightly proud of the impact that their profession has on people’s health. The great majority of Americans will use prescription drugs during some period in their lives, relying on them to reduce pain, promote recovery, fight disease, or minimize the effects of some health problem.

“Medications are not just an occasional need in society,” says Stephen Schondelmeyer, a pharmaceutical economist. “They’re something that everyone, from babies to the elderly, needs at some point. There’s literally universal demand for medications.”

But while prescription and over-the counter medications have the potential to do much good, they are not without dangers. Pharmacists, doctors, and other health care advocates have long been concerned about drug interactions, which can result in unintended adverse effects or may reduce the efficacy of one or all of the medications a patient is taking. “Every drug has risks and the potential to do harm if not used properly,” Schondelmeyer says. And in today’s health-care environment, in which doctors often lack time to ask patients which prescription drugs, over-the-counter medications, and even herbal remedies they’re taking, the risks continue to multiply.

For some Medicare patients, however, help and hope may be just around the corner. On January 1, 2006, individuals who spend more than $4,000 annually on multiple drugs for chronic conditions and who are enrolled in Medicare-eligible programs will be able to receive consultation without cost regarding their medications. Health-care providers seeking Medicare reimbursement must provide Medication Therapy Management (MTM) services under rules established by Congress with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The MTM provision will go into enforcement at the same time as the new Medicare drug benefit.

Of course, a patient might choose to review his or her medications with a doctor, a nurse, or other health care professional, rather than a pharmacist. But Schondelmeyer, noting that the law specifically mentions that “drug therapy management may be furnished by a pharmacist,” says that individuals trained in pharmacy are best equipped to deal with issues of drug interaction, dosage requirements, medication timing, and other matters. “Someone needs to take responsibility to assure that medications are used in ways that they have the best possible chance of improving a patient’s health care, rather than causing more problems,” he says. “And pharmacists are trained to do just that.”

While many pharmacists have long been willing to talk with individuals who have questions about particular drugs, they’ve not been compensated for it. The new requirement guarantees that MTM is available to individuals who desire it and, furthermore, some of the prescription drug plans may pay pharmacists for providing MTM services. (At this writing, however, the Center for Medicare and Medicaid Services had yet to approve any of the plans proposed by health-care providers for administering MTM. Pharmacists may or may not be an integral part of provider plans.)

But companies that do provide quality MTM may stand to reap the greater benefits. A 2003 study by University of Minnesota researchers found that when pharmacists and physicians worked together with patients to examine potential drug interaction problems, they resolved an average of 2.3 drug therapy problems per patient. Another ongoing study suggests that MTM can reduce total health-care costs by 15 to 20 percent per patient, making it an attractive option for insurers and patients alike in an era of skyrocketing health-care costs.

“If we can work with a prescription drug plan and achieve even a 5 percent reduction, we’ll be bucking the trend in health care costs,” Schondelmeyer says. With that potential impact, Medicare patients may not be the only ones talking about MTM in the near future.