Reimbursement model for pharmacist-directed medication therapy management.

Area of Science:

• Health Services Research
• Pharmaceutical Practice
• Health Economics

Background:

• Self-insured health plans present opportunities for direct provision of pharmacy services.
• Medication Therapy Management (MTM) can optimize pharmacotherapy and improve patient outcomes.
• Developing sustainable reimbursement models is crucial for expanding MTM services.

Purpose of the Study:

• To outline the creation of a practice model for MTM services.
• To establish a sustainable reimbursement strategy for pharmacists serving self-insured populations.
• To demonstrate the applicability of the model in employer and community pharmacy settings.

Main Methods:

• The Auburn University Pharmaceutical Care Center (AUPCC) was established to serve a self-insured employee population.
• A practice model and reimbursement strategy were developed and implemented.
• The model's adaptability to community pharmacy and state employee plans was assessed.

Main Results:

• AUPCC serves as a replicable model for pharmaceutical care in the workplace.
• The model was successfully adapted for Alabama state employees in 2010.
• The practice demonstrates potential for cost-effective pharmacotherapy and improved medication use.

Conclusions:

• Pharmacists can directly negotiate MTM service provision with self-insured employers.
• This represents a viable area for professional growth and sustainable practice development.
• The model supports improved medication management for employee populations.