Rite Care pioneers medication management therapy

Drug Store News, July 11, 2005 by Michael Johnsen

PITTSBURGH -- Rite Aid last month went live in four Pittsburgh pharmacies with a first-of-its-kind medication management therapy program it's calling Rite Care, where the pharmacist counsels patients on the use of their medicines and how best to manage their health conditions.

Not that pharmacists haven't been counseling patients on the use of their medicines since the beginnings of the drug store business. It's just that now Rite Aid has officially put it on the menu, so to speak, setting up a private office for consultation and charging an established fee.

And the chain has a proactive outreach program to area physicians that serves two purposes: letting area doctors know that Rite Aid's specially trained pharmacists are augmenting their patients' care--not competing for it--and that Rite Care pharmacists can spend significantly more time with patients than time-crunched doctors. The program with the physicians also includes Rite Care referral slips and Rite Care posters for the waiting room.

"At the conclusion of every one of these patient assessments, we provide the patient with a written care plan, and then we also provide a pre-formatted note to the physician [via tax]," noted Greg Drew, Rite Aid's vice president of pharmacy health services, who spearheaded the Rite Care program. "At the end of the day, we're looking to [accomplish] a combination of improving patient care for all the folks that come in to Rite Aid relative to their medication therapy management and their disease states and at the same time build the case for a compensation model for pharmacists providing an extended level of patient care," Drew said.

Rite Aid charges an $80 fee for the initial 45-minute session, which involves a brown-bag medicine cabinet review with the pharmacist, including over-tile counter remedies and nutritional supplements, with the goal of developing a truly comprehensive medication management therapy program customized for the patient's needs. Subsequent visits depend upon how complex the program becomes. "In some cases, we'll want to see the patients [relatively soon]," Drew explained, to make sure they understand the plan and to monitor how those patients are progressing with any change in therapy. For patients who are doing well, it may only be an annual visit, Drew said. "A lot of that is going to have to do with the assessment of the pharmacist who's providing the services," he noted.

Subsequent visits cost between $10 and $20.

To qualify as a Rite Care pharmacist--there currently are five pharmacists rotating through the four stores--Rite Aid's pharmacists must take an approximate six-week course for 20 hours per week. Rite Aid and the University of Pittsburgh School of Pharmacy co-developed the curriculum, which is focused largely on counseling patients on medication therapy management. A computer program, also co-developed between Rite Aid and the University of Pittsburgh, helps guide the counseling sessions.

"During the training, the focus is really on the patient assessment and how to develop a care plan for the patient," Drew said. MTM pharmacists are expected to push beyond counseling and help identify gaps or problems in therapy and help address those issues.

Consequently, the curriculum covers the waterfront of health conditions and the appropriate management of medications--not just the typical menu of blood pressure monitoring, diabetes or asthma education and immunization services typically associated with the neighborhood drug store. "If you look at the CMS definition for patients that will qualify under Medicare Part D, it's multiple disease states, multiple drug regimens," Drew said.

The Rite Care program puts Rite Aid in position to offer MTM services to qualified Medicare patients and be reimbursed as a Part D provider starting in January.

"At the same time, we are equally excited about approaching the commercial market," noted Drew, "and having employees and insurers recognize the value of these pharmacist services and ... compensate for those services." And Rite Aid already is lining up payers for the new service. "We are in discussions right now with two entities, one an insurer and one a managed care employer in the Pittsburgh area."

Rite Aid plans to expand the Rite Care concept across the chain following a thorough evaluation of the Pittsburgh pilot, which could take the chain into the first half of next year before a market-by-market rollout could begin in earnest.

One thing Rite Aid executives are anxious to determine is how many MTM centers will be necessary to support a given market. "When you start looking at 3,400 stores, it's very important to understand what patient base is going to be the driver for these centers of excellence, Drew said. At the outset, Rite Aid's four MTMS centers serve a store base of 40 to 50 Rite Aid locations today, each of which will make referrals to the MTM stores, working out to about one MTMS center for every 10 stores in a given geographic area, for now.