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Have you ever heard the joke about the guy caught in a flood. To escape the flood he climbs up onto his roof. As the water continues to rise a man on a makeshift raft passes and offers him a ride, to which he responds “No I’ve been praying, God will save me.” The water rises to his belly button at which point a woman in a canoe passes and offers him another ride and again he responds “No I have been praying, God will save me.”  Finally, just as the water is getting to the man’s nostrils, a motor boat passes and offers the man a ride and yet again he responds “No I have been praying, God will save me.” As the motor boat cruises off into the distance the water rises above the man’s head and he dies. When the man reaches heaven and encounters Saint Peter, he asks “I prayed and prayed, why didn’t God save me?” To which Peter replies “God sent a raft, a canoe and a motor boat, why didn’t you take one of them to safety?”

As I field calls from pharmacists every week asking me about MTM, I am reminded about the plight of this man.  For the most part, pharmacists are looking for me “to send them cases” so they can “do an MTM” and “get reimbursed.



The fact is, MTM cases are passing right in front of pharmacists every day. They are built right into the prescription base. MTM is an easy reason for physicians to refer new patients to you.  If you don’t have an MTM program up and running, then you are missing the MTM boat, and in turn, all of the benefits of MTM.

Yes I said it – All of the BENEFITS!

Take, for example, the case of diabetic medication. The literature tells us that adherence in diabetic patients, while varying widely by population (36-93%), is somewhere in the 63% range in most populations. So when you put on your pharmacy business hat, this means that most pharmacists fail to realize approximately 37% of the potential revenue in their prescription base.  To drive home the point, let me frame this a different way. Let’s say your pharmacy generates $500K in prescription revenue monthly (~300 prescriptions per day). You can assume that approximately 12% of your patient population is diabetic, so in rough terms ~40 prescriptions per day are for diabetes. At an average prescription cost of $72 per prescription, diabetics generate ~$2800 of revenue daily or $63K monthly.  The problem is that at a 63% adherence rate you are losing ~$1,600 of potential revenue daily, $35,000 monthly, $420,000 per year!  To add insult to injury, with diabetic medications you are getting hit with the double whammy of DIR fees.

Are you still waiting for somebody to send you MTM cases?



There are a lot of similar situations where MTM can benefit your pharmacy

Therapy Gap Impact on Pharmacy
Long Term Inhalers are notoriously underused and misused Lost Potential Revenue
Physicians who need to do a medication review post discharge Lost New Patients
Hospitals who will be penalized if a patient returns within 30 days Lost New Patients


What is the problem then? Why can’t pharmacists seem to “get into the MTM boat.”  Pharmacists DO have barriers to getting MTM programs up and running. In general, we are not terribly well socialized and trained to put together MTM programs. Please note, that I specifically use the term “put together.” While I believe that a pharmacy education has been providing the fundamental components for developing MTM programs for decades, I am not convinced that pharmacists are being trained and socialized to assemble these components into a robust, reliable program.

Key areas to consider when assembling an MTM program:

Focus. Each one of the areas I have described presents a focus for a medication management program. That’s correct – a focus. In my discussions with pharmacists, I find that a big barrier to setting up an MTM program is that they quickly become overwhelmed by the scope of the program.  Begin with a single program, a very focused therapeutic aim and a tractable population. There is no crime in starting small.

Process. Develop and hone your MTM process. This is also a key barrier to pharmacists developing an MTM program. When I ask pharmacists what specifically they will do to close therapy gaps they have a high level response (i.e. I’ll counsel them), but they don’t have a boots on the ground plan (i.e. a protocol). An MTM program is essentially a protocol, same as a clinical study protocol.  If you want your MTM program to have a demonstrable effect on your pharmacy’s performance, then you have to have a protocol and adhere to the protocol.

  • How will you select patients for the program?
  • What are the specific aspects of the patient interaction?
  • What are the key elements to be documented?
  • How will track the impact on your pharmacy?

Market. The last point is critical if you intend to expand your program and convince payers to reimburse you.  If you can’t demonstrate to yourself that your program can create impact, you won’t be able to demonstrate this to others (payers). The results of your program’s impact are your marketing material.

As always, I am happy to discuss your medication therapy management program. CSS supports ACOs, integrated care delivery systems pharmacists and physician groups to design, implement and manage medication management programs. Feel free to reach out by phone or e-mail.

Jim Notaro

716.541.0273 x101

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