Key informant perspectives on facilitators for pharmacist payment of medication therapy management services

Opportunities for pharmacist payment of medication therapy management (MTM) services vary significantly by state and payer. While previous research has identified barriers and facilitators with setting up pharmacist MTM services, adoption of payment remains low.

The primary objective of this qualitative key informant (KI) study was to identify themes for successful payment of pharmacist MTM services.

KIs who were obtaining or pursuing compensation for pharmacist MTM services were recruited via a Qualtrics survey to evaluate their eligibility for the study. If eligible, semistructured interviews were conducted via Zoom from November 2024 to March 2025. Interview transcripts were coded for thematic analysis, and themes were mapped to the Consolidated Framework for Implementation Research domains.

Code saturation was reached with 15 interviews. All KIs were pharmacists, with 53% in leadership roles and MTM billing duration ranging from 3 months to 19 years. Payment modalities included MTM codes, incident-to, other Evaluation and Management and care management codes, grants, cash pay, and fee-for-service contracts. Eighteen themes were identified in individual, process, inner setting, and outer setting domains. Six key actionable steps for pharmacists interested in pursuing billing included the use of external individuals or community partnerships to navigate billing issues, use of pilot testing to generate outcomes, use of integrated billing and documentation systems to increase operational efficiency, use of support staff to increase financial sustainability, establishment of a workflow to address payment issues, and creation of a tracking system to support ongoing billing.

While current pharmacist MTM payment modalities do not entirely compensate for pharmacist costs, pharmacists are successfully obtaining payment for their services. Future advocacy efforts need to focus on establishing consistent billing requirements and increasing payment for service sustainability, as well as educating pharmacists and billing professionals on billing opportunities.