Pharmacists spend much time bemoaning the fact that only a few insurers pay for medication therapy management services. Rightly so, and it’s mostly true. But there’s a sizable payer group that probably doesn’t get the amount of attention from pharmacists as they deserve. I’m referring to self-funded employers.
Similar to many payers, most HR managers or CFOs who oversee pharmacy programs for employers have misconceptions or are simply uninformed about the role of pharmacists and MTM. Many believe that because they’ve contracted with a PBM their enrollee’s medication management needs are met. Of course, pharmacists know that’s not true. To counter this perception I will explain to employers that while PBMs may manage a drug formulary and administer a benefit program, they are usually not well suited to deliver personal, one-to-one patient care services such as MTM. As pharmacists, we can use the now abundant evidence to convince payers that MTM services will provide a financial return of greater than 3:1, often much more.
Like many of our patients, the employer may also believe that physicians are managing medications for their patients. Explain that pharmacist-provided MTM is done in collaboration with the patient’s physician, and perhaps illustrate the benefit of this collaboration with a positive example or two from one’s own practice. But the bottom line is this: business people understand dollars. Explain the value of MTM in terms of ROI and chances are good that they will understand you.
What type of employer to approach? Most likely, every good sized community has at least one employer of substantial size with a self-funded pharmacy benefit. A local hospital might be a perfect target. A private college in the community is another. Any employer with whom the pharmacist already has a well-established relationship with senior management makes perfect sense. I’ve personally had success working with a hospital system in my community. I knew the medical director and had a good connection to the human resources director. By presenting significant results of my pharmacy’s program to both of these “key influencers” within the organization I was able to gain crucial support. Barriers I encountered were minimal, but were managed as described above and by understanding and carefully explaining why a pharmacist brings added value through MTM.
MTM has been proven to provide a favorable ROI and improve clinical outcomes. Payers though, especially self-funded empolyers, must be educated to the benefits of MTM for their enrolled population. Pharmacists should seize the opportunity now and show the value of pharmaceutical care services. It is possible to convince a business person that MTM makes sense. I’ve done it, and I’ll continue talking with business leaders in my community whenever I get the chance. It’s been said before – we’re at the crossroads. Don’t wait for others to sell the value of pharmacist provided MTM. Talk to a business leader yourself and make it happen.
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