What are Paid Clinical Opportunities and is Your Pharmacy Taking Advantage of Them?

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What are Paid Clinical Opportunities and is Your Pharmacy Taking Advantage of Them?

Medication adherence is one of the most important aspects of successful patient care. For pharmacists, ensuring that their patients are taking their medications properly isn’t the only reason to promote medication adherence—Medication Therapy Management can also boost their bottom line. Medication Therapy Management (MTM) results in valuable reimbursement funds for pharmacies.

So where do paid clinical opportunities come in? Paid clinical opportunities function similarly to MTM, but also offer a separate opportunity to accrue reimbursements from Pharma and Payor organizations.

Even the most experienced and savvy pharmacists may not be aware that they’re missing out on these revenue opportunities. In this blog, we take a look at the benefits of both Medication Therapy Management and paid clinical opportunities, as well as offer insight into why it’s important to take advantage of them.

What Qualifies as Medication Therapy Management?

Medication Therapy Management is a term used to describe a broad range of healthcare services commonly provided by pharmacists. At its core, it refers to a distinct service or group of services that optimize therapeutic outcomes for individual patients. Additionally, most service models include the following items:

  • Medication therapy review (MTR)
  • Personal medication records (PMR)
  • Medication-related action plan (MAP)
  • Intervention and/or referral
  • Documentation and follow-up

With all of these in place, pharmacists can better provide Medication Therapy Management to help patients get the best benefits from their medications by actively managing drug therapy, as well as identifying, preventing, and resolving problems associated with said medications.

How Does MTM Make Money for Pharmacies?

Income streams from MTM are varied, including:

  • Direct reimbursement for comprehensive medication reviews (CMR)
  • Direct reimbursement for targeted medication reviews (TMR)
  • Indirect reimbursement from decreased direct and indirect remuneration (DIR) fees based on improved quality ratings

All of these things can greatly boost a pharmacy’s bottom line. But the benefits to correctly performing MTM are more than just financial.

How Do Patients Benefit from MTM?

Cost Effectiveness

A Medication Therapy Management can lower the overall cost of prescription drugs. MTM emphasizes prescribing the right medications while eliminating unnecessary medications that could create potential complications or adverse side effects.

Reduced Number of Hospital Stays and Doctors' Visits

Adherence to an MTM can lead to fewer medical emergencies and doctor’s visits because it reduces complications caused by medication. By adhering to a medication regimen, patients can avoid complications that could lead to an emergency room visit or a trip to the doctor’s office due to complications.

Better Patient Outcomes

Including the Pharmacist as part of the Care Continuum provides patients with an additional layer of support to ensure follow-through on their physician’s orders and that their prescriptions are not causing adverse side effects. When patients have a team of healthcare professionals working together to get their medication right and minimize discomfort, patients are more likely to stick with treatment that improves their overall quality of life.

What Is the Difference Between MTM and Paid Clinical Opportunities?

Paid clinical opportunities simply provide another source of income for similar medication adherence efforts, but this time the reimbursements come from Pharma and Payor organizations. Unfortunately, not all pharmacy management software solutions work with Pharma and Payor companies, which makes achieving paid clinical opportunities more difficult for some pharmacies.

If your pharmacy wants to incorporate paid clinical opportunities into your reimbursement processes, Outcomes® may be the right solution for you. Our diversified software works with your pharmacy to maximize reimbursement opportunities, including those from Pharma and Payor organizations. Want to learn more or schedule a demo?


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