A division of CareFirst BlueCross BlueShield covers medication therapy management for seniors under the Medicare Part D plan which, by law, requires patients to receive counseling for prescriptions. A spokesman said the insurer is monitoring that program to decide whether it should be expanded to other groups, but pointed out it could increase premium costs.
Pharmacists say that every patient should have access to such services.
"I'm not talking about you coming to the drug store and consulting with you over the counter," said Magaly Rodriguez de Bittner, chairwoman of the department of pharmacy practice and science at the University of Maryland School of Pharmacy. "You should have the right to sit one-on-one, privately with the doctor and someone reviewing your medication."
In an era of mail-order prescriptions, earning a living as a clinical pharmacist has been a topic of intense discussion at the school, which has taught medication therapy management since 1993. Some leaders in the industry are encouraging students to become business savvy to survive in a changed field.
Pharmacists should market themselves as medical specialists and advocate for increased reimbursement instead of "giving their services away," Daniel Buffington, president and CEO of Florida-based Clinical Pharmacology Services, told students during a lecture last month.
Rodriguez de Bittner thinks that despite the business challenges, medication therapy management will soon become standard practice in all pharmacies. Not only do patients need such guidance, but managing prescriptions can cause fewer medical errors and cuts health care costs for doctors' visits and hospitalizations.
Medication errors are among the most common medical errors, injuring about 1.5 million people annually and costing hospitals about $3.5. billion a year, according to a 2006 report from the National Academies' Institute of Medicine. The report suggests that more monitoring from pharmacists can prevent problems.
For two years, the school has operated a program in which pharmacists coach diabetics to manage their disease, with the goal of improving health and decreasing health care costs. Known as P3, it began in Western Maryland and last year expanded to Harford County. Four private employers pay pharmacists for the service, and patients receive counseling at no cost to them.
But some Harford County doctors, who provide similar services but require a co-pay for the visits, say the P3 program puts them at a disadvantage.
"It's one thing if you're in a rural area and don't have the education resources - this is a nice program that supplements patient care," said Dr. David Hexter, president-elect of the Harford County Medical Society. "But it seems unfair to steer patients away from the medical home by waiving co-pays and deductibles."
Still, Rodriguez de Bittner argues that in the long run, the program will cut health care costs, which practitioners of all stripes should embrace.
"The employers are realizing that the solution to decrease health care costs is taking advantage of the pharmacist as the medication expert," she said.
