Pharmacy's MTM Challenge (rerun)

I’m taking a break from blogging this week and rerunning some of my favorite posts from 2010. Click here to see the original post and comments from March 2010. Sorry that I couldn't get to NACDS in Boston due to Irene!

President Obama signed the Patient Protection and Affordable Care Act into law on Tuesday. Section 3503 describes new programs for Medication Therapy Management (MTM) services provided by licensed pharmacists. I’m a fan of the MTM concept because it should improve health care outcomes and reduce costs.

But many pharmacies will have to rethink their businesses to allow store-based pharmacists to take full advantage of MTM opportunities. The latest National Pharmacist Workforce Survey (NPWS) shows pharmacists perceive themselves as overworked and not able to spend enough time on patient care services.

MTM money will presumably provide the financial incentives to fix this misalignment, but money won’t be enough. The pharmacy industry will have to rethink its business model while simultaneously navigating an increasingly competitive environment focused on low-cost prescription fulfillment, pharmacy automation, and call-center counseling from mail-order pharmacies.

The big 3 Pharmacy Benefit Managers (PBMs) with mail pharmacies have already figured this out. Manufacturers should be thinking about how to support pharmacy-based MTM services that will benefit adherence and compliance.

OVERWORKED

Almost 7 out of 10 pharmacists (across all practice settings) rate their workload level as "high" or "excessively high." Pay attention to the big jump versus 2004.The chart below is based on responses from 905 pharmacists and appears on page 41 of the 2009 NPWS. (Click to enlarge.)

The average brick-and-mortar pharmacy has also gotten much busier. The average chain pharmacy filled about 81 thousand prescriptions per year in 2008, up sharply from roughly 59 thousand per year filled in 1998. The average independent pharmacy also filled more prescriptions in 2008 versus 1998.

UNSATISFIED

The Workforce survey also asked pharmacists about what they actually do each day and what they want to be doing each day. Here are the two major categories used in the survey:

• Medication Dispensing: preparing, distributing, and administering medication products, including associated consultation, interacting with patients about selection and use of over-the-counter products, and interactions with other professionals during the medication dispensing process.
  
• Patient Care Services: assessing and evaluating patient medication-related needs, monitoring and adjusting patients’ treatments to attain desired outcome, and other services designed for patient care management.

As you can see below, retail pharmacists want to be more involved in patient care services compared to their current workload (-12 point gap), but medication dispensing crowds out those activities.

Two notes:

• The original data appear on pages 50 and 52 of the NPWS. Since the results did not differ significantly across pharmacy formats, I computed a weighted retail average from the Independent, Chain, Mass Merchant, and Supermarket responses.
• The survey’s definition of Medication Dispensing contains some elements of “Medication Therapy Management.” The Other category (not broken out in my chart) showed pharmacists wanting to do less business management and more research or education.

BOTTOM LINE

When thinking about MTM in light of the data above, I'm reminded of something I learned in grad school.

In theory, theory and practice are the same thing.

In practice, they’re different.