Patient compliance and medication therapy management



Andrew Tolve talks to Jim Owen, director of professional practice, the American Pharmacists Association, about how medication therapy management can improve adherenceand offer opportunities for pharma

As poor adherence rates persist alongside frequent medication mismanagement, some pharmacists wonder if they can play a more active role in ensuring successful medicine outcomes.

Enter medication therapy management (MTM), a new model that expands the pharmacists role from a mere distributor to a consultant, educator, and conduit between patient and physician and patient and manufacturer.

Improving adherence is one piece of MTM, but the larger objective is to guarantee that patients are taking the right medicines, not just adhering to the medicines they have been prescribed.

We feel that pharmacists can play a major role in the appropriate selection, monitoring, and maintenance of those patients on drug products, says Jim Owen, director of professional practice, the American Pharmacists Association.

We want to make sure theyre getting the proper treatment and the best outcomes that they possibly can. (For more on the pharmacists role, see The pharmacist's role in patient adherence, The pharmacist as an ally in patient adherence and How pharmacists can help improve patient compliance.)

As pharmacies launch pilots and search for ways to make MTM viable, pharma will have various opportunities to capitalize on the trend.

MTM as an add-on service

The American Pharmacists Association (APhA) represents 62,000 pharmacists across a range of practice settingshospitals, long-term care, community pharmacy, and pharmacy academia.

In 2003, APhA was notified that Medicare Part D would include a designation for an MTM program for beneficiaries.

The association drafted a consensus definition in 2004 and became a hub for MTM Medicare Part D services.

More recently, the organization has begun championing a broader application of MTM.

In conjunction with the National Association of Chain Drug Stores Foundation, APhA has developed a baseline model for community pharmacies and national chains to consider.

The model positions MTM as an add-on type service in addition to effectively and faithfully distributing medication, Owen says.

Pharmacists will provide comprehensive medication reviews that check for medication appropriateness, problems with adherence, and problems with side effects or adverse events.

Pharmacists will then develop a plan to address those problems and work with patients and their healthcare providers to improve medication use and outcomes.

In some cases, they may offer pharmacogenomic applications or monitor drug administration, like new forms of injectables.

We believe the pharmacist model of the future is that community pharmacies will be service-based entities that will encompass, in addition to the products they dispense, a wide variety of these service offerings under the umbrella of medication therapy management, Owen says.

MTM in action

Some US national chains have already launched pilot MTM programs.

Rite Aid has introduced Rite Care, an MTM service provider under Medicare Part D as well as a pharmacy-oriented profit center.

Initial sessions with a pharmacist cost $80, last 45 minutes, and offer comprehensive reviews of all the patients prescription and over-the-counter medicines. Follow-up visits cost $10 to $20.

Rite Aid has rolled out Rite Care in Pittsburgh stores. Kroger has embraced MTM pilots as well.

Meanwhile, on the regional level, chains like Kerr Drug in North Carolina have adopted MTM full-force, Owen says.

A group of Kerr Drug clinical team members cover the chains region, providing services in stores, in the community, and at employer sites.

The chain also has opened facilities in rural North Carolina that have no dispensing pharmacy in them.

Instead, they function as healthcare centers that bring in other healthcare providers, like nutritionists, to help with certain disease state management.

They have really changed their business model to functionally be healthcare providers, Owen says.

He believes that as economic pressures increase on pharmacies, more and more chains will follow Kerr Drugs example.

If youre going to strictly rely on the dispensing of medications with the shrinking of margins and the shrinking of reimbursement for pharmacy, in the future thats going to be a very difficult thing to do, Owen says.

Opportunities for pharma

Medication therapy management offers a number of opportunities for the pharma industry.

On the adherence front, pharma companies could sponsor MTM sessions to ensure patients have a better understanding of their drugs.

The results of a six-month multi-state pilot program of sponsored MTM sessions involving one big pharma firm are scheduled to be published this year.

The goal of the pilot is to create a communication strategy for pharmacists when dispensing the companys product.

That communication includes counseling and education about adherence.

Obviously, adherence for manufacturers is an entre point, says Owendue to the easily measured outcomesbut he believes thats only one of many models for involvement.

Another opportunity is risk evaluation and mitigation strategy, or REMS.

Manufacturers could use pharmacist MTM sessions with patients as a way to conduct post-marketing surveillance on adverse events, drug-drug interactions, side effects and so on.

Some manufacturers are already working with APhA on this front.

When you start looking at individuals that service the number of patients that a regional chain the size of Kerr Drug services, the amount of data you can gather regarding post-marketing surveillance on adverse events and monitoring for REMS is quite astounding, Owen says. (For more on REMS, see Market access: How to get REMS right and The Impact of REMS on Market Access.)

A third possibility for pharma is sponsoring targeted medication reviews in which pharmacists look for red flags associated with treatment when a patient comes to get a refill or to fill a new prescription.

While these targeted reviews may cause a pharmacist to lead a patient away from a brand, Owen says manufacturers are starting to express an altruistic belief that they just dont want people to take medication, they want people to take the right medication.

Whatever route pharma decides to go, Owen assures that these options promise a stronger ROI than simply sponsoring pharmacist adherence letters.

Personal interaction through medication therapy managementwhether its addressing adherence or its a targeted intervention or its a comprehensive medication reviewis going to be much more effective than the investment youre making into an adherence mailing.

For more on MTM, join the sectors key players at Patient Adherence, Communication & Engagement Europe on May 31-June 1 in Berlin.


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