From left: Jeremy Fyke, Robert Yale and Natalie Litera

By Jessica Harvey
Senior, PR

A group of department graduate students have uncovered some major barriers to implementation of a Medicare mandate, and their results are attracting nationwide attention.

Under the guidance of department Associate Professor Melanie Morgan, a team of department graduate students completed an assessment of Medication Therapy Management Services at the request of the Indiana Pharmacist Alliance in 2008 and are now expanding the study to other states.

MTMS are mandated by the Medicare Modernization Act of 2003 and target elderly patients with annual out-of-pocket prescription costs exceeding $4,000. The study, completed by the Purdue team of Robert Yale, Natalie Litera, Jeremy Fyke and Corinne Corbett, included a survey and interviews with 87 pharmacists to determine how well MTMS are carried out by Indiana pharmacists, barriers posed to MTMS, and recommendations to overcoming those barriers.

MTMS are designed for qualifying patients to meet individually with their pharmacists for consultation. The meeting can last anywhere from 15 minutes to 90 minutes and is designed to aid the safety of the patient by allowing the pharmacist to identify any drug conflicts, or save the patient money by identifying available generic medications or drugs the patient is taking but no longer needs.

"Patient safety is the key component of MTMS and what it provides. Insurance companies have the biggest incentive to make sure MTMS take place," said Yale.

The study revealed pharmacists overwhelmingly believe the program is beneficial.

However, the study uncovered multiple barriers to MTMS in Indiana, with lack of time for a pharmacist to adequately conduct MTMS sessions being the largest. Pharmacists in large drug store chains often have to meet prescription filling quotas and lack sufficient time to meet with patients qualifying for MTMS. Reimbursements to the pharmacists for MTMS have been viewed as minimal, given other demands on their time.

"MTMS can be perceived as extra work for pharmacists, but the lower costs of medications (as a result of MTMS) can offset the costs of the consultations," said Yale.

Other barriers include a lack of managerial support and inadequate patient education and awareness that MTMS are available. The Medicare program has been notifying pharmacists when patients qualify for MTMS, but that method alone doesn't ensure MTMS will take place.

The team developed recommendations in response to the barriers they uncovered. Recommendations to key barriers include: designate specific day and time blocks for pharmacists to conduct MTMS to avoid pharmacy operation conflicts; delegate responsibilities to pharmacy techs and others to free pharmacists for MTMS; and promote patient awareness of program.

"The recommendations are what they are and we want to get the results out to pharmacies and pharmacists in Indiana. MTMS are better for patients and the bottom line," Yale said.

An article summarizing the research was published in Indiana Pharmacist, and a more comprehensive explanation of the study, the identified barriers, and recommendations for overcoming the barriers has been published by the International Journal of Pharmaceutical Compounding. This summer the group continued to push ahead, contacts at other professional pharmacy organizations were made, and during the coming months, the study will be revised and replicated in Maryland, Iowa, Arkansas, Louisiana, and Arizona.

The study continues to draw attention in more mainstream media as well. Most recently, Scientific Frontline detailed this study.