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From the Center for Medicare and Medicaid Services. But like I said nearly no one knows any of this. Go into any pharmacy and ask the pharmacist about “MTM” a

From the Center for Medicare and Medicaid Services. But like I said nearly no one knows any of this. Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction. Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. Again you can ask nearly any pharmacist and they have an outcomesMTM portal that feeds them automated recommendations on behalf of the insurance carrier. Some of the bigger pharmacies, like Wal-Mart, have even removed the MTM portals from the individual stores already and created nationwide MTM centers. I even know of one company who uses pharmacy students (for free) to do this work for the insurers. Here is another tidbit for every recommendation the portal gives the pharmacist the pharmacy gets a “tip” (ie monetary bonus) to forward that to the doctor and if the doctor makes the change the pharmacy gets another tip. The only reason the insurers link up with the pharmacists to do their dirty work instead of the doctors directly is the insurers can’t pay the doctors the way they pay pharmacists to do their work bc of anti kickback laws. >Pharmacists cannot just ask doctors for prescription modifications. Again try asking any practicing family physician, ask them how many faxes they get a day from pharmacies requesting they change the patient Rx.

vonmoltke 8y ago
> From the Center for Medicare and Medicaid Services. Please direct me to citations, not "try asking any X". > Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction. MTM has nothing to do with insurance. > Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. outcomesMTM is not insurance software, it's pharmacy patient management software. > Here is another tidbit for every recommendation the portal gives the pharmacist they pharmacy gets a “tip” (ie monetary bonus) to forward that to the doctor and if the doctor makes the change the pharmacy gets another tip. That you need to substantiate with more than just "go talk to pharmacists", particularly in light of the above. > Again try asking any practicing family physician, ask them how many faxes they get a day from pharmacies requesting they change the patient Rx. I've had my pharmacy request changes on my behalf, if it was something simple (like getting the wrong dosage), and they have done so as a convenience, not because they were required to. I have never had them request a change without my consent or knowledge, and I would stop using such a pharmacy if it ever happened. You have also completely ignored what I said about prescription changes not being necessary for generic substitution.
- will_brown 8y ago
  You are asking me to cite things but what are you citing? You are simply saying “that’s not true”. >MTM has nothing to do with insurance. It’s required by law To be provided by insurers/health plans. If you refuse to talk to pharmacists or doctors about it, fine, you can read the law 42 CFR 423.153. In short insurance companies, must provide MTM services to patient covered in their plans. It is also the single biggest metric in determining an insurers star rating. How could it possibly be unrelated to insurance if insurance companies have to, by law, provide it and it effects their reimbursement/star ratings? >outcomesMTM is not insurance software, it's pharmacy patient management software. That’s funny...the software certainly does manage pharmacists...on behalf of the insurance companies. Right from the outcomes homepage: “Contracted with more than 50 U.S. health plans, OutcomesMTM provides MTM coverage to 5.5 million patients. The company links more than 100,000 local chain, independent and health-system pharmacy providers with contracted plans across the country.” Why does outcomesmtm contract with 50 insurance companies? Why does outcomesMTM “link” pharmacies with contracted plans? “Targeted MTM services are designed to help plan sponsors improve performance for key Star measures, including the triple-weighted adherence measures. Prompted by TIPs in the Connect™ Platform, pharmacists work with patients to impact adherence and optimize medication regimens.” As to generic substitutions...there are laws from state to state that allow pharmacists to do it, UNLESS the doctor says the name brand must be dispensed. I’m afraid that’s common practice, so permission is required. Plus when it comes to Medicare patients a pharmacist isn’t going to just change the RX to generic because they know they: 1 get paid by the insurer through these MTM portals to make the recommendation and 2 get paid again through the portal if/when the doctor agrees to the change.
  - Wowfunhappy 8y ago
    > You are asking me to cite things but what are you citing? GP cannot prove a negative. If this software/system exists, the "burden of proof" is on you.
    - will_brown 8y ago
      He said mtm has nothing to do with insurers and ask “where I got my ideas” I said CMS and cited the Law that Medicare insurers have to provide mtm to patients. Then he said outcomesMTM is a pharmacy patient management software having nothing to with insurance, but it’s a software for insurers to pay pharmacies to provide mtm to the insurers patients and I quoted from their website. It’s really above and beyond ridiculous like me saying google is a search engine and someone say no it’s not give me a cite.

vonmoltke 8y ago

> From the Center for Medicare and Medicaid Services. Please direct me to citations, not "try asking any X". > Go into any pharmacy and ask the pharmacist about “MTM” and gauge their reaction. MTM has nothing to do with insurance. > Look at outcomesMTM they are 1 of the 2 dominate insurance software vendors. outcomesMTM is not insurance software, it's pharmacy patient management software. > Here is another tidbit for every recommendation the portal gives the pharmacist they pharmacy gets a “tip” (ie monetary bonus) to forward that to the doctor and if the doctor makes the change the pharmacy gets another tip. That you need to substantiate with more than just "go talk to pharmacists", particularly in light of the above. > Again try asking any practicing family physician, ask them how many faxes they get a day from pharmacies requesting they change the patient Rx. I've had my pharmacy request changes on my behalf, if it was something simple (like getting the wrong dosage), and they have done so as a convenience, not because they were required to. I have never had them request a change without my consent or knowledge, and I would stop using such a pharmacy if it ever happened. You have also completely ignored what I said about prescription changes not being necessary for generic substitution.

will_brown 8y ago
You are asking me to cite things but what are you citing? You are simply saying “that’s not true”. >MTM has nothing to do with insurance. It’s required by law To be provided by insurers/health plans. If you refuse to talk to pharmacists or doctors about it, fine, you can read the law 42 CFR 423.153. In short insurance companies, must provide MTM services to patient covered in their plans. It is also the single biggest metric in determining an insurers star rating. How could it possibly be unrelated to insurance if insurance companies have to, by law, provide it and it effects their reimbursement/star ratings? >outcomesMTM is not insurance software, it's pharmacy patient management software. That’s funny...the software certainly does manage pharmacists...on behalf of the insurance companies. Right from the outcomes homepage: “Contracted with more than 50 U.S. health plans, OutcomesMTM provides MTM coverage to 5.5 million patients. The company links more than 100,000 local chain, independent and health-system pharmacy providers with contracted plans across the country.” Why does outcomesmtm contract with 50 insurance companies? Why does outcomesMTM “link” pharmacies with contracted plans? “Targeted MTM services are designed to help plan sponsors improve performance for key Star measures, including the triple-weighted adherence measures. Prompted by TIPs in the Connect™ Platform, pharmacists work with patients to impact adherence and optimize medication regimens.” As to generic substitutions...there are laws from state to state that allow pharmacists to do it, UNLESS the doctor says the name brand must be dispensed. I’m afraid that’s common practice, so permission is required. Plus when it comes to Medicare patients a pharmacist isn’t going to just change the RX to generic because they know they: 1 get paid by the insurer through these MTM portals to make the recommendation and 2 get paid again through the portal if/when the doctor agrees to the change.
- Wowfunhappy 8y ago
  > You are asking me to cite things but what are you citing? GP cannot prove a negative. If this software/system exists, the "burden of proof" is on you.
  - will_brown 8y ago
    He said mtm has nothing to do with insurers and ask “where I got my ideas” I said CMS and cited the Law that Medicare insurers have to provide mtm to patients. Then he said outcomesMTM is a pharmacy patient management software having nothing to with insurance, but it’s a software for insurers to pay pharmacies to provide mtm to the insurers patients and I quoted from their website. It’s really above and beyond ridiculous like me saying google is a search engine and someone say no it’s not give me a cite.