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APhA CEO Blog

Talking MTM and the clinical role of pharmacists at CMS

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October 27, 2009

On Friday, I went to the Centers for Medicare & Medicaid Services (CMS) to meet with CMS top leadership ─ Acting Administrator Charlene Frizzera and several of her key Medicare staff. I had the opportunity to introduce her to APhA, our top priorities related to Medicare, and the clinical role of pharmacists. We highlighted APhA’s MTM resources, our support for the expanded MTM provisions in the 2010 Medicare Part D plan year and the CMS proposed rule (released the day before), and our interest in working together with CMS to address MTM implementation challenges, both in the current Medicare program and in new provisions that may be a part of health care reform.

I’ve heard from many MTM practitioners that inconsistencies among various billing systems are one of the biggest challenges we face in broad deployment. Thus, I was pleased that the CMS staff was interested in better understanding MTM billing and documentation challenges and in helping to address these issues. CMS seemed interested in working with us to improve the situation with the plans.

We also highlighted the success of pharmacists providing immunizations and using this model to expand beneficiary access to preventive services, such as diabetes screening. I appreciated that CMS recognized that the clinical role pharmacists could play is limited by the lack of Medicare Part B status. CMS also acknowledged “provider status” as being a big lift.

CMS appreciated that APhA expressed our support for e-prescribing while continuing to point out the challenges with the quality of e-prescription and the time that pharmacists spend fixing or clarifying e-prescriptions. We will continue to explore ways to work with CMS and other stakeholders on e-prescribing quality improvement.

We also used the opportunity to express to CMS our support for efforts to reduce medication waste through utilization management (first-fill) techniques. I also noted the need to work together to ensure that such initiatives in any practice setting work for patients, pharmacists/pharmacies, and CMS.

We’re staying close to CMS and working hard to be there when regulators begin to focus on whatever bill the White House ultimately signs regarding health care reform.