Reimbursement model for pharmacist-directed medication therapy management

J Am Pharm Assoc (2003). 2012 Mar-Apr;52(2):161-9. doi: 10.1331/JAPhA.2012.11228.

Abstract

Objective: To describe the development of a practice model with sustainable reimbursement for medication therapy management (MTM) services provided by pharmacists for beneficiaries of self-insured health care plans.

Practice description: The Auburn University Pharmaceutical Care Center (AUPCC) is a free-standing clinic located within the school of pharmacy that provides preventive care and MTM services for a population of 11,600 employees and dependents that subscribe to the university's self-insured health plan. The goal of patient care is to increase use of cost-effective pharmacotherapy and improve the outcomes of medication use among the population.

Main outcome measures: Development and implementation of a practice model and reimbursement method that can be implemented in the employer setting for large self-insured employers and the community pharmacy practice setting.

Results: Since opening, AUPCC has developed into a model pharmaceutical care service that can be implemented in the workplace for other self-insured employers. AUPCC is also a model that can easily translate to the community pharmacy setting. In 2010, the model was adapted by Alabama for state employees.

Conclusion: Pharmacists can negotiate directly with decision makers within large companies that are self-insured to provide MTM services for the employee population. This is an area of sustainable growth within our profession.

MeSH terms

  • Alabama
  • Health Benefit Plans, Employee / economics
  • Health Care Costs
  • Humans
  • Models, Economic*
  • Pharmaceutical Services / economics*
  • Pharmacists*
  • Professional Role
  • Reimbursement Mechanisms*
  • Student Health Services