Many patients need another service they're even less likely to get than routine prescription counseling: medication therapy management.
This review of all the medications a patient is taking -- including over-the-counter medications, herbal products and dietary supplements, as well as prescription drugs -- can take up to an hour for the first session, with follow-ups possible. Though it's not required by law, it's crucial to ensure that none of the patient's medications are duplicating each other, or canceling each other out, or interacting in a problematic, even dangerous way. Such problems arise most often, but not exclusively, with patients who are taking five or more medications that may well have been prescribed by more than one physician.
In medication therapy management, the pharmacist can work with a patient's physician (or physicians) to develop a comprehensive program of drug therapy -- perhaps eliminating or adding or switching medications. Often this ends up saving the patient money and, more important, improving the patient's health.
"Pharmacists can't do this by themselves," says Anne Burns, vice president for professional affairs for the American Pharmacists Assn. "But they bring a unique expertise to the table. And by relieving some of the burden on physicians, it frees them up to concentrate on diagnosis."
Some insurance plans, but not all, cover medication therapy management. Medicare Part D mandates it for certain patients but does not require it to be done by pharmacists, so some insurers use minimal in-house programs, says Jeff Goad, an associate professor at the USC School of Pharmacy. All proposed healthcare reform bills currently provide for some form of compensation for medication therapy management.
But for now, the only way many patients can get this service is by paying for it out of pocket -- if their pharmacist offers it at all. True, if they're really lucky, patients may find a pharmacist who doesn't charge for it. But in the long run, such pro bono help is untenable, says Kathy Besinque, an associate professor at the USC School of Pharmacy who also works part time at Patton's Pharmacy in Santa Monica.
"Everybody needs to get paid for their time," she says.