But pharmacists say the model is struggling, as overburdened primary care doctors have less time for patient counseling. Meanwhile, more patients have chronic diseases and are taking numerous medications, increasing the need for supervision and advice.
The medication therapy management model can succeed only if doctors and pharmacists join forces, said Brewer, who has partnered with the Wyman Park practice for a decade. Brewer is employed by Hopkins and bills for his services separately from the doctors at the practice. His patients' insurance covers their visits with him.
Statewide, it's unclear how many pharmacists and doctors have such an arrangement, although many in the industry project the number to grow.
Typically, pharmacists like Brewer are employed by hospitals and work with family practices affiliated with the institutions. In 2002, a state law enabled pharmacists and doctors to enter such agreements directly. The agreements must be approved first by the Maryland Board of Pharmacy. In some cases, the agreements allow pharmacists to change a patient's medication dosage without sending the patient to a physician first.
The concept is actually an old one, dating back generations when pharmacists at neighborhood apothecaries knew their patients' names, what ailed them and how to treat it.
Today's clinical pharmacy is geared toward patients like Davis, with complex medical histories and numerous medications. Besides diabetes, Davis, a retired manager at the Social Security Administration from Baltimore, also has hypertension, high cholesterol, angina and glaucoma in her left eye. She takes six prescription medications.
Brewer said his job is also to help prevent chronic diseases and when possible, prescribe fewer medications. He sits down with patients for 20-minute to 30-minute sessions, usually quarterly, but sometimes as often as every month. They map out goals and strategies to manage diseases and prevent new ones.
"If we can focus on the underlying causes of these diseases - tobacco, obesity, lack of exercise - then you can really start to get a handle of the medication being prescribed," he said.
While many pharmacists have long done more than count pills and dispense drugs, some insurers have not embraced the expanded role.
