The Scary Future of MTMs

If you have been listening to the recent news and trends in the pharmacy industry any time in the past few years the chances are that you have heard of medications therapy management programs (MTMs or also called MTMPs).

"Medication therapy management, also referred to as MTM, is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team." - APhA

MTMs were first mentioned in the Medicare reform under President George Bush and have shown to decrease healthcare costs significantly as well as show increased patient compliance and overall improvements in healthcare quality. MTMs have a big role in the future of pharmacy and could really develop a new face for the profession.

There is one key thing to all of this, however. MTMs must be performed in the right way, with physicians and patients who are open to the concept. This way the programs can have optimal results and show other professional and members of the public the benefits of having a pharmacist perform such activities.

I recently found out, through a source not to be named, that a major chain pharmacy is rolling out an "MTM" program. This program however is being done in a very poor manner. The chain is trying to force all of their pharmacists to participate, even those who are older and not fully up to date with current practice guidelines. This chain is also having pharmacists call physicians office and recommend adding/changing medications, which may sound like a good idea however, these pharmacists are doing so with no lab work, no practice agreements with physicians or with patients and nor formal training in how to run or operate and MTM program!

The practicality of this chain's "MTM" setup is just atrocious. How many physicians are open to a pharmacist (or anyone) calling them and recommending they put their patients on more medicine or changes in dosages, outside of the normal calls that occur already? How many patients really want to be on more medications? From my own experience both of these issues provide serious obstacles that I do not see going over very well for the pharmacists involved.

The main problem here is greed. This chain is not reimbursing their pharmacists any more for their time spent performing MTM services. They are forcing them to do all of this on top of giving flu shots, filling the same number of prescriptions (if not more caused by the calls they will be making), answering phone calls, counseling patients and any other duties that need to be performed. This chain has held stagnant is sales while others have increased over the same time period, thus they are trying to increase business by forcing pharmacists to make more phone calls. I am curious to see if the chain will also try to bill insurance companies, particularly Medicare, for these MTM services and how successful they will be in doing so. Let us not forget that all of this is also occurring after this chain cut both pharmacist and technician hours. YIKES!

Another thing that worries me here is the lack of cohesion that this may cause in the pharmacy industry. Accrediting bodies have fought long and hard to get these type of programs set in place and reimbursement for these services, which is great! They have also established residency programs with the specific focus of MTMs and have recently established a board certified program for these types for these types of positions. This chain is single-handedly degrading everything these bodies have worked for by having under qualified professionals perform these duties.

Now, before everybody thinks I am demeaning MTMs I must say that I am in full support of MTM programs and really believe that they are a great thing for pharmacists to be involved in. The provide a great benefit to both the patient, the payer and the healthcare system. That being said, they should be done correctly and rolled out in a manner where all participants are accepting of it. It should not be forced on pharmacists, physicians and patients like this chain is essentially doing.

The problem here is a simple one to me. Too many under qualified pharmacist will be forced to execute MTM services in a poor manner. This could potentially lead to resistance to it's acceptance and eventual adoption into the healthcare system. This would be greatly disappointing because of the potential delay in improved healthcare, education and substantial money saved. I would love to see these types of programs rolled out over the whole U.S.A., I believe the way to do it is start in a manner that will be better accepted by all participants. A suggestion of mine would be to start in smaller areas where pharmacists, physicians and patients all, generally speaking, know each other a little better. This much has already happened to some degree, seeing as how many independent pharmacies currently provide these services. The chains need to start in a similar fashion and be sure to include such services in a manner that takes pressure off of the pharmacist so they are performing these services while prescriptions and other duties are piling up on them. This may mean that one pharmacist has to cover a few different stores until the program is more widely accepted but at least a properly trained professional will be focused and undistracted from what they are to do. This is an idea the previously stated chain is clearly not concerned about.

The biggest thing here is that pharmacists need to step up and show what they can do, but stop trying to be Superman and do everything all at once, which sadly is what we are known for doing. I would love to see MTM services rolled out in a greater scale but I am afraid if not done correctly it could cause years of delays in acceptance and costing this country a lot of money in several different ways. I hope this chain realizes their soon to be potential misstep and really thinks about what they are doing. The problem is stock prices and greed may win out.

(Note: I have left out several citations for fear of fully divulging which chain this is. Any comments left after this are not mine and that of individuals who do not speak on my behalf.)

Weight Loss Clinics, Marketing at It's Finest!

America is obese.

This we know.

Because of this people are looking to others for help them lose the weight. I see a great deal of people who ask questions about what works best for weight loss. Many of these patients want to try a quick fix pill or a trendy diet and see results in a week or two. Lots of questions have recently focused on the Jillian Michaels line of diet pills or Hydroxycut. Both of these medications are choc full of stimulants like caffeine that may help in weight loss, but also can raise blood pressure increase, affect sleep patterns and induce heart palpations among other detrimental side effects. Proof in this is just how many times Jillian Michaels has been sued over her diet pills, here is one example. A lot of patients do not understand this and thus are glad when I give them my professional input.

So if a pharmacist knows, wouldn't a weight loss clinic be a great place to try to find my answer?

Although this sounds logical, I would vehemently disagree, and here's why...

Weight loss clinics really play on insecurities of those who are either insecure or desperate enough to ask for professional help to lose weight. However, many of these clinics are nothing more than business fronts that can be fairly lucrative, especially since a lot of these patients usually have good occupations and are willing to pay out of pocket for the services that are rendered.

I had a patient who came into my pharmacy today who really verified what I feel about most weight loss clinics. Possibly even worsening it.

A 30 something year old, well dressed, African American female came into my pharmacy with 2 prescriptions, one for Adipex and one for Lasix. Due to my states stringent laws regarding weight loss medications, I was forced to call the "physician's" office to get the patient's BMI since it was not written on the prescription. While I was dialing the patient walked over to the closest area to me she could and asked me, "Why do you need to call? I have been on this before!" Thus another hurdle my state law gives me is that a patient can only be on Adipex for 12 weeks then MUST take a 6 month break before resuming therapy. Sure enough, she had this medication 3 months prior and was in violation of the previously stated law. Great...

I approached the patient and explained the laws to her and showed her that I had written the date of the last time she had the medication filled, since it could not be legally filled. We went back and forth a little bit, both arguing our points, until she finally asked me, "Why is this so hard to get my weight loss medicine? It's not like this stuff kills people!"

She must have been a carpenter because she hit the nail on the head!

I then explained to the patient about why the combination of Phen-Fen, was taken off of the market and how medications like Adipex may cause health problems. She gave me a baffled look. I also explained to her that by taking the second prescription, Lasix, would cause her to be dehydrated, causing her heart rate to increase and thus cause even more stress on her system. Although, I know some physicians do this, I am not a fan of it. "Well I have had issue of my heart rate going crazy and I have been drinking a lot of water and sucking on cough drops but my mouth is always dry. Do you think this could be why?" I told her it very well could be asked her a few more questions and deduced that it was probably due to the medications she was given.

This is when she dropped a bomb on me.

"Well ya know when I go in there, no doctor even sees me. I only see a few assistants who weigh me, ask me what weight I want to get to, nod their head and give me these scripts. They never really tell me nothing!"

Lovely... Just frickin' lovely! Now I know the "physician" who signed these prescriptions didn't even see her! Even worse, she wasn't really sure if the assistants she saw had any degree above a nursing degree (note, I clarified and she meant RN. She knew they were not CNPs or allowed to prescribe). She said they always left then came back with the prescriptions in hand. That's gotta be legit, right?

I then shared a brief story with her about a patient I had previously who was given diet pills from a weight loss center that were put in a pill bottle with a label that only read, "Diet Pills, Take 1 with breakfast and 1 with lunch". This was done to cover up the fact that the drug was not legal in the USA. By law the label MUST have the drug name, dose, quantity, directions, prescriber and the place they were filled at (if not more in some states). My current patient then said, "Well they did give me Adipex out of their office, that's why I waited so long before bringing in this prescription." Even better! Now they are handing out schedule III medications, like they are blue M&M's!

After explaining to me that she no longer trusted the less than legitimate weight loss center, she asked me "Well what can I take to lose weight

Ah, the trillion dollar question is what is the magic pill to help us lose all this weight? The answer is simple.

NONE!

That's right there is no magic pill that will magically make you lose all of those pounds you put on by being lazy, slacking off and eating like crap. Some pills may help but the only healthy to lose weight is at the very least to watch what you eat and then add exercise as seen fit.

I explained this concept to her, politely, as I could see she was lacking confidence in medical professionals, and she was very grateful. I can't say that I changed the world for her or even solved her problem BUT the one thing that makes me feel good about this situation was the fact that I educated somebody (who hopefully will tell others) about a shady weight loss clinic. I can only hope that this place gets shut down as it is clearly just a money scam that really does not care about the size and health of their patients but rather the size an health of their wallet. This is literally finding a market that there is expendable money, targeting it, and then maximizing it's efficiency to increase profit. What a scam! More proof of marketing at it's finest!

That being said there are many gastroenterologists and other physicians who are more than willing to ETHICALLY and PRACTICALLY help their patients lose weight. I applaud their efforts. However, it truly saddens me how some people have gone so far to turn the practice of medicine and the use of pharmaceuticals into a drive thru business.

One more reason why taking time when necessary can make a difference in your patients health.