A New Role for the Profession in Medicaid

By now, you probably are aware that the Texas Pharmacy Association, the UT College of Pharmacy and the Texas Health and Human Services Commission have launched the “Clinical and Economic Outcomes of Texas Medicaid Medication Therapy Management (MTM) Pilot.”  As a result of TPA’s urging during the last state legislative session, this pilot was funded by the legislature to determine the potential cost savings associated with MTM for certain Medicaid patients.  This is yet another step to improve the health of our state’s most financially challenged residents while reducing the state’s Medicaid funding challenges .  It also takes a step forward in establishing a paid service – delivered by pharmacists – that broadens the role of the profession.

Pharmacists are expected to deliver Comprehensive MTM, not just the “typical” Basic MTM which focuses on drug therapy problems that can be identified solely from medication history such as drug interactions, adherence, cost-efficacy, etc.  Comprehensive MTM also includes pharmacist assessment of clinical targets and medication therapy recommendations with changes being recommended to the prescriber when clinical targets are not being met.

Enrollment of pharmacists interested in this pilot program is well underway.  The scope of the study is limited to any pharmacist in the Austin-San Antonio corridor or the Houston area.  The pharmacist must have a Texas license in good standing and currently be serving Medicaid patients taking five or more medications for chronic conditions, at least one of which is for treating hypertension.  No additional training or certification is required.  The pilot is expected to cover about 700 patients.

Through the pilot and Outcomes, the Texas Pharmacy Association will reimburse participating pharmacists who provide MTM services for eligible patients and who document activities and results in the web-based Outcomes system.   And the pharmacist only needs  internet access and be registered with Outcomes.  If you are not an Outcomes user, you can register without charge.

I hope you will take a step forward to join this effort, but keep in mind that whether or not you have an interest, are in the pilot locations or have the qualifying patients, this pilot is a first step.  Once the report is provided to the Agency and the Legislature, there will be savings from the effort and there likely will be an expansion of the concept.   Got questions?  Please contact Kim Roberson at TPA at kroberson@texaspharmacy.org.

More to come . . .

Joe DaSilva

Chief Executive Officer

Texas Pharmacy Association