Chapter 14: Information on Employers that Hire MTM Pharmacists
CMS’s passage of the MMA in 2003 opened the door for MTM services and, subsequently, opportunities for pharmacists and other MTM providers. With guidance from the APhA, pharmacists, and training programs have been able to create MTM programs that provide a great benefit to Medicare Part D patients. As MTM services have matured over the last two decades, the benefits of MTM services to the entire health system have become more evident. Conversely, the initial challenges faced by those providing MTM have been discovered, helping the practice to evolve and more closely fit the needs of those in need of complex medication management.
The maturation of MTM services has led to the development of programs in many different sectors of healthcare. Pharmacists or other professionals interested in pursuing a career that includes the provision of MTM services can find several different avenues for entry into practice. The types of employers that generally offer employment for MTM pharmacists fall into the following broad categories:
- Retail chain pharmacies
- Independent pharmacies
- Independent contractors
- Product, device, and logistics suppliers
- Health information companies
- Medication Therapy Management clinical service providers
In general, retail chain pharmacies are well-known, but their MTM services may be localized to specific stores or locations. Opportunities within chains may be highly regionalized or specific to location offerings. Those MTM providers looking for opportunities in chain pharmacies should inquire within their specific region.
Independent pharmacies often offer MTM services, but this will vary by store. The employers available in this area are too numerous and specific to list. An interested pharmacist should research independent pharmacies in their area to find these types of job opportunities.
Independent contractors may be “gig economy” workers like those employed by AspenRx Health, or they may have established individualized contracts with healthplans to provide services for there area. This practice is discussed elsewhere in the document.
The companies listed below fall into categories four through six. Many of those listed did not start by offering MTM, but exist somewhere else in the healthcare supply chain and started offering MTM after 2003. However, some of the companies arose specifically to provision MTM services and have specialized in the practice.
AdhereHealth™ is headquartered near Nashville in the town of Brentwood, TN. The company provides solutions for healthplans, employers, and providers. Their offerings include technologies that leverage analytics to improve value-based care and meet CMS benchmarks.
AdhereHealth™ champions their product OptimizeMTM™, as a data-driven software as a service (SaaS) that can be tailored to meet the needs of the healthplan or employer. Companies that contract with AdhereHealth™ can expect that those analytics are used to identify patients that qualify for MTM services. AdhereHealth™ then makes a contact attempt through the mail.
If a patient responds to the offer for CMR, a representative at AdhereHealth™ facilitates an appointment with one of their licensed pharmacists. Once the appointment is complete, the pharmacist provides the patient with a Medication Review Follow-up letter. Pharmacists work for AdhereRx™, a division of AdhereHealth™.
Aledade is a Care Transformation Organization (CTO) based out of Bethesda, MD. They partner with primary care physicians and physician groups to facilitate the operation of Accountable Care Organizations (ACOs). Aledade operates across 25 states and is in partnership with 300 physician practices. Aledade also partners with healthplans and assists them with setting performance goals for physicians and incentivizing value-based care. When healthplans partner with Aledade, they receive access to ACOs that Aledade has helped to facilitate and create.
Aledade employs Centralized Medication Management Pharmacists as part of their ACO teams. The pharmacist reaches out to patients via telephonic appointments and performs medication-related interventions. Pharmacists also conduct medication reconciliation of post-discharge patients to help with transitions of care. The pharmacist may also perform care coordination activities like reaching out to pharmacies, providers’ offices, care managers, and patients themselves.
Anthem, Inc is a leading healthplan with several affiliated companies that serve 41 million patients across the United States. The affiliated companies include Preferred Provider Organizations (PPOs), Health Maintenance Organizations (HMOs), specialty pharmacy services, and companies that provide dental coverage. Anthem, Inc partners with employer groups to provide comprehensive healthcare coverage products.
Anthem, Inc partner companies offer MTM services as part of their benefit offerings for Part D enrollees. Anthem plans that offer MTM programs follow CMS criteria for enrollment of eligible patients and offer patients a yearly CMR as well as quarterly TMRs.
Anthem, Inc pharmacists support disease state management programs through telephonic MTM services. They offer yearly CMR telephonic visits to those eligible and enrolled in the MTM program. Pharmacists serve as a resource to the clinical team, as well as providers for patients enrolled in the healthplan’s MTM services. The pharmacist focuses on high-risk patients with polypharmacy, potential drug interactions, drug-disease interactions, and other issues that may lead to adverse health outcomes.
Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan is a Medicare Part D sponsor and the largest health insurer in Michigan. The company is a nonprofit mutual insurance company founded in 1939 and serves over 4.5 million people in Michigan and 1.6 million people in other states. They encompass the largest network of doctors and hospitals in the state of Michigan.
The MTM program offered by Blue Cross Blue Shield of Michigan follows CMS eligibility rules, and patients who participate in their Part D plans and meet eligibility criteria may enroll. The company’s MTM services mirror the standard offerings, and they provide a once yearly CMR and quarterly TMRs.
Blue Cross Blue Shield of Michigan has a team of Clinical Pharmacists that support MTM services and initiatives within the healthplan. The pharmacists contribute to the clinical team by supporting the clinical review of medication requests, developing drug formulary, and supporting cost-saving initiatives and opportunities. The employment resources for MTM pharmacists at Blue Cross Blue Shield of Michigan do not mention if the pharmacist directly participates in CMRs or TMRs for the patient population.
Cardinal Health is a healthcare service and products company with a variety of offerings for health systems, hospitals, ambulatory clinics, pharmacies, surgery centers, and clinical laboratories. Cardinal Health participates in the supply chains for prescription drug products and medical products and devices. According to Cardinal Health, they serve almost 90% of hospitals in the United States as well as 29,000 hospitals. Recently the company has expanded into specialty drug and nuclear medicine offerings.
Cardinal Health offers a unique opportunity for pharmacists to work remotely while getting the chance to function as MTM providers. They have offerings for both full-time and part-time pharmacists in any state in which they hold their license. MTM pharmacists perform CMRs, TMRs, medication reviews, adherence monitoring, cost-saving interventions, formulary interchange suggestions, and other interventions that optimize care. Pharmacists at Cardinal Health will contact patients, physician offices, and participating pharmacies to offer therapeutic suggestions. Cardinal Health employs APhA’s five core elements of MTM: CMR/TMR, PMR, MAP, interventions and referrals, and documentation of services.
Clinical Support Services, LLC
Clinical Support Services, LLC (CSS Health) is a company that offers population health solutions to healthplans, pharmacies, self-insured businesses, pharmacy benefit managers, and third-party administrators. CSS Health offers MTM solutions tailored to each of these types of companies.
CSS Health offers several opportunities for pharmacists looking to practice MTM services, including a PGY-1 residency. CSS Health started the residency in 2014, and it is designed to prepare pharmacists to practice in a managed care setting based on medication management principles and knowledge. The resident completes one year of learning that prepares the resident to provide clinical services on both individual and population levels. Newly graduated pharmacists looking to build a strong foundation in Medicare Part D will find many valuable training experiences, including the development of drug information databases, clinic programs, and sales and marketing techniques.
CSS Health also employs pharmacists and other staff to support their products. Their product for Medicare Part D healthplans is a SaaS called Smart™. Smart™ is an analytics software that audits patient records for medication-related problems, drug interactions, and other issues. Smart™ is paired with CSS Health’s clinical outreach center, where pharmacist team members leverage the analytics data to implement cost reduction strategies.
Cureatr is a novel comprehensive medication management company that hires board-certified pharmacists. Board-certified pharmacists for Cureatr utilize the Meds 360° software to perform comprehensive medication management. Cureatr’s Meds 360° offers a comprehensive real-time view of patient medication history, seamless, real-time communication, and transparency of health information. Once a patient population is enrolled in Cureatr’s CMM program, a board-certified pharmacist would engage the patient, develop a care plan for the patient, and follow up with the patient to improve health outcomes.
Humana is a healthplan based out of Louisville, Kentucky, which serves over 13 million members in the United States. Humana is the third-largest healthplan in the country.
Humana offers MTM services to its Part D members as part of their yearly and quarterly benefits. Patients qualify if they have three of the five following conditions: heart failure, rheumatoid arthritis, diabetes, dyslipidemia, or asthma, and they are taking eight or more prescription medications, and they meet the required yearly CMS spend. Humana patients who are eligible will be auto-enrolled, at which point they can visit a participating pharmacy for an MTM appointment, or they can schedule a telephonic appointment with a Humana pharmacist trained in MTM.
Pharmacists who work at Humana may provide yearly CMRs and quarterly TMRs for patients eligible for MTM services. Pharmacists also participate in other managed care activities, including formulary management, cost-saving initiatives, and clinical outreach for Humana members. Pharmacists are a vital member of the Humana clinical team and provide drug information support for physicians, nurses, and other healthcare professionals in Humana and the Humana network.
McKesson Corporation is a pharmaceutical distribution company that delivers to a variety of clients, including hospitals, clinics, oncology infusion suites, retail chain pharmacies, and independent pharmacies. McKesson also delivers healthcare products outside of pharmaceuticals, including medical/surgical equipment, technology solutions, and medical devices. McKesson is headquartered out of Irving, Texas, and delivers to healthcare companies throughout North America and Europe.
McKesson’s primary offering for MTM services is achieved through McKesson Pharmacy Systems (MPS) Business Services. MPS Business Services markets products designed for retail pharmacies to meet changing market trends, including clinical services and reimbursements. MPS Business Services provides MTM software solutions that help a pharmacy identify opportunities for CMRs and TMRs. Once identified, the pharmacy can take advantage of reimbursement opportunities.
McKesson hires pharmacists to fill part-time and full-time retail pharmacist shifts for their customers in some regions of the country. The on-demand pharmacist should be familiar with MTM, but whether the pharmacist performs MTM services as part of their job function will be based on the retail pharmacy in which they hare staffing.
Medication Management Systems, Inc
Medication Management Systems, Inc offers MTM technology solutions to assist with the provision of MTM services for Medicare Part D sponsors. In 2017 Medication Management Systems, Inc was acquired by Genoa Healthcare, a leading provider of psychiatry and telepsychiatry pharmacy services in the United States.
In contrast to many other companies that offer MTM services, Medication Management Systems, Inc offers CMM, rather than traditional MTM services. CMM is similar to MTM because it fulfills Medicare Part D requirements and includes one annual CMR. CMM builds upon MTM by also including multiple pharmacist follow-ups, personalized care plans with therapy goals, and is an ongoing process.
Genoa Healthcare is a retail pharmacy chain that focuses on long-term care and psychiatric medications. They hire across 48 states and provide services tailored to psychiatric patients, including bubble-packing medication, adherence reminders, and psychiatric pharmacist specialists. Genoa has incorporated the tools from Medication Management Systems into their pharmacies under the name “MMS Assurance Pharmaceutical Care System.” Genoa pharmacists use these software tools to provide ongoing CMM services to their patient population.
MedWatchers is an MTM company that offers services to self-insured employers, Medicare Part D sponsors, commercials healthplans, state Medicaid plans, and others. MedWatchers boasts a high CMR completion rate with 4- and 5-star ratings from CMS.
MedWatchers directly hires pharmacists to perform MTM services out of their locations in San Diego, CA, and Orange County, CA. MTM pharmacists at MedWatchers discover patients in need of CMR and TMRs and contact them to offer a person-to-person appointment. Pharmacists will then identify gaps in care and potential medication-related issues. The prescriber’s office is contacted as needed, and case reports are prepared for the patient and their primary care provider (PCP).
Mirixa Corporation is a technology solutions company that assists in the provision of MTM services. Mirixa was recently acquired by Cardinal Health, a parent company of OutcomesMTM. See OutcomesMTM for further information.
Molina is a healthplan and managed care company headquartered in Long Beach, CA. They provide healthplans for the CMS programs Medicare and Medicaid. They also offer insurance plans for individuals through state healthplan marketplaces or exchanges.
Molina directly offered MTM services for their healthplan patients that meet specific criteria. Patients are eligible if they have three or more of the following conditions: heart failure, diabetes, dyslipidemia, hypertension, depression, or COPD, they take at least eight medications, and they meet the minimum annual Part D spending criteria. Patients that meet these criteria are automatically enrolled in Molina’s MTM program.
Molina’s MTM services include a yearly telephonic CMR that lasts about 30 minutes. The MTM provider will generate and deliver a PMR by mail, as well as a MAP. The MTM provider may or may not contact the patient’s provider to resolve medication-related problems.
Molina hires pharmacists to perform clinical and MTM services to meet the needs of their patients. MTM pharmacists are responsible for formulary management, reviewing provider utilization patterns, and managing dispensing pharmacy costs through different initiatives. The MTM may also perform additional clinical pharmacy services as indicated, including drug monitoring, regimen review, and patient education. Completion of APhA’s Medication Therapy Management Certificate Training Program is a preferred qualification for this position.
OutcomesMTM is a Cardinal Health company that provides MTM programs and services via their network of pharmacists. OutcomesMTM has been operating for over 20 years, even before CMS passed legislation in 2003 to mandate yearly MTM for Part D members. OutcomesMTM (Cardinal Health) acquired Mirixa Corporation in early 2019. The platforms have been merged, and MTM pharmacists may now use whichever program best fits the needs of themselves and their patients.
OutcomesMTM connects with healthplans across all 50 states, as well as local pharmacies for a total coverage area of 6 million patients. The company serves chain, independent, clinic, and hospital pharmacies. Pharmacists and their teams may participate in the OutcomesMTM Personal PharmacistTM Network for free. Pharmacists can then leverage the OutcomesMTM platform to advertise their services to participating healthplans.
Since OutcomesMTM mostly contracts with already established pharmacy practices, they do not typically hire MTM providers themselves. However, they have a non-accredited PGY1 residency program. The program lasts for 12 months and is a Managed Care Systems Pharmacy residency. The resident is based out of Des Moines, IA, and training includes a variety of MTM-related services. Residents are trained in clinical protocol development, sales and marketing, network contracting, quality assurance, MTM benefit design, data management, research, and other areas.
In 2019 PharmMD changed its name to AdhereHealth. See the AdhereHealth™ entry for employer information.
Prime Care Health Solutions
Prime Care Health Solutions is a company that contracts with healthplans, physician practices, employers, and individuals to deliver clinical pharmacy programs, including MTM services. Prime Care Health Solutions focuses on delivering clinical pharmacy services that emphasize care management, disease prevention, and disease management. They design their programs to deliver cost-savings initiatives and increased positive patient outcomes.
Prime Care Health Solutions employs both pharmacists and pharmacy technicians on their clinical MTM teams. Pharmacists champion clinical pharmacy outreach, including MTM services. Pharmacists audit patient medical records and directly reach out to patients for cost-savings and patient safety initiatives. When the pharmacist is performing MTM for healthplans, they also troubleshoot prior authorization claims. The pharmacist also acts as a liaison between the patient and the prescriber’s office for medication-related recommendations.
SinfoníaRx is a provider of MTM services, and they offer healthcare solutions for patients, healthplans, and clinics. The company was initially established in partnership with the University of Arizona College of Pharmacy in March 2006. They provide their MTM services via the Medication Management Center (MMC), which is a group of centralized providers at the following locations:
- Drake University Clinical Intelligence Call Center
- Oregon State University (OSU) Medication Management Program
- SinfoníaRx: Florida
- SinfoníaRx: Florida
- SinfoníaRx: Phoenix
- SinfoníaRx: Texas
- SinfoníaRx: Tucson
SinfoníaRx offers products all along the spectrum of healthplan patients, including commercial, private, Medicare, Medicaid, and exchanges. The primary driver for the clinical pharmacy work is their SaaS offerings, which The SinfoníaRx Medicare MTM program and CompanionRx™.
SinfoníaRx’s software runs continuous algorithmic TMRs that audit the patient profile every time a prescription claim is run, every time a chronic medication fill is due, and when new information is added to a patient’s profile.
SinfoníaRx has career opportunities for pharmacy technicians, pharmacy interns, and pharmacists. All positions work as part of the team to work directly with patients, providers, and community pharmacists to deliver care. Pharmacists examine medical records to identify patients that are candidates for CMR. Appointments are telephonic, and pharmacists may provide drug education as well as identify medication-related problems. Current pharmacist positions are part-time.
The PillHelp Company, LLC
The PillHelp Company, LLC, is a unique service designed for patients, prescribers, and pharmacists. The PillHelp Company markets its PillHelp Works® software as a tool for pharmacists to establish and run and independent office-based practice.
Physicians who work with The PillHelp Company are encouraged to refer any patient they feel need MTM services, regardless of coverage. Since the company uses non-traditional billing, they are not limited by how often or how much insurers agree to pay for MTM services. Providers should refer their patients who have polypharmacy complications. PillHelp pharmacists focus on patient education, reduction of polypharmacy, and avoidance of costly medication errors.
Rather than hire pharmacists directly, The PillHelp Company empowers pharmacists who wish to provide MTM services through their PillHelp Works® software. The software utilizes CMS standards of MTM care and provides intervention documentation, patient communication tools, invoice tools, and others. The software is cloud-based.