Pharmacists' acceptable levels of compensation for MTM services: a conjoint analysis

The Medicare Modernization Act of 2003 requires prescription drug plans to provide medication therapy management (MTM) services to Medicare beneficiaries who are at high risk for inappropriate use of medications. However, inadequate compensation has been a barrier for MTM expansion among pharmacists.

The objective of this study was to determine pharmacists' acceptable levels of compensation for MTM services.

A preference-based fractional factorial design of conjoint analysis was used by surveying 1524 active pharmacists in Tennessee. Pharmacists were asked to select between packages (scenarios) of MTM services that represented combinations of MTM attributes (characteristics). The MTM attributes included type of patient (new or returning), patient's number of chronic conditions (1, 3, or 6), patient's number of medications (4, 8, or 16), patient's annual drug costs ($2000, $3000, or $4000), service duration (15 minutes, 30 minutes, or 45 minutes), and price of MTM services ($30, $60, or $120). A survival analysis model was used to predict pharmacists' willingness to select 1 versus another MTM service package. Pharmacists' acceptable level of compensation was estimated as the marginal rate of substitution between the parameter estimates of an attribute and the price attribute of MTM.

The parameter estimates were -0.0303 (P<.0001) for service duration and 0.0210 (P<.0001) for price of MTM services, respectively, so pharmacists were willing to accept $1.44/min (0.0303/0.0210), or $86.4/h, for MTM services. Pharmacists' characteristics were associated significantly with their acceptable levels of compensation: years of practice was associated with a higher need for compensation, pharmacy ownership (vs nonowner) associated with a lower need, and having provided MTM previously (vs having not provided MTM) was associated with a higher need.

Pharmacists' acceptable level of compensation is in the higher part of current ranges from $30 to $100/h. To increase participation in MTM services, pharmacist compensation needs to be increased. Future studies might continue to corroborate the generalizability of findings from this study.