The speakers have no conflicts in relation to this presentation.Christian Tadrus is on the Board of MPA and MO PCN Leader

Current Legal Issues in Missouri Health-system

Pharmacy Practice April 10, 2010

Nancy Konieczny, R.Ph. M.B.AChristine Swyres, R.Ph., Pharm.D.

Christian Tadrus, R.Ph., Pharm.D., FASCPGreg Teale, Pharm.D.

Missouri Pharmacy Coalition• The Missouri Pharmacy Coalition facilitates alignment

among pharmacy organizations and collaborates with other healthcare organizations to improve patient care outcomes and foster timely change.

• Organized in September 2008, the Coalition has met five times.

• Composed of members from academia, health system, independent retail , chain, long term care, consulting and nuclear pharmacy practice.

Missouri Pharmacy Coalition Vision and Projects

• The Missouri Pharmacy Coalition is the unified voice catalyzing implementation of best practices that improve patient care outcomes.

• Medication Management Therapy (MTM)

• Collaboration on potential fall meeting to educate pharmacists about new MTM rules

MTM in Missouri Current laws in the State of Missouri do

not define Medication Therapy Management (MTM) and the rules applying to hospital pharmacy practice do not address the tasks and responsibilities a pharmacist can and cannot engage in. 

Examples include collaborative agreements with your medical staff.

MTM in Missouri• 2007 Legislative Session

– State Legislature passed the Pharmacy Practice Act

– Missouri Revised Statutes - Chapter 338– http://www.moga.mo.gov/statutes/C338.HTM

• Promulgating Rules– The state board of registration for the healing

arts and the state board of pharmacy will jointly promulgate rules regulating the use of protocols for medication therapy services.

What is MTM?(6) Modifying Drug Therapy. If allowed in the written protocol, a pharmacist shall be authorized to modify a patient’s non-controlled substance medication therapy, subject to the following:

(A) Modifying medication therapy may include initiating, selecting, modifying or administering medication therapy or devices, …or selecting a different strength, dose, dosage form, dosage schedule or route of administration if the medication or device and the criteria for such modification or selection are specifically identified in the written protocol.

Examples of Protocols• Vancomycin Dosing• Renal Adjustment of LMWH• Warfarin Dosing Protocols• IV to PO Protocols• Immunization Screening

Protocols• Therapeutic Interchange

Protocols

Credentialing• Pharmacist must receive a certificate from

Board of Pharmacy to participate in MTM• Fee tied to the statute to participate in

MTM ($50)• Bachelor trained pharmacists will

need to go through additional training to be allowed to participate in MTM

• Physician or physicians will determine the privileges of the pharmacist

Board of Pharmacy MTM Committee

• Board of Pharmacy, Department of Health, MSHP, MPA and Schools of Pharmacy

• Credentialing and Privileging • Definitions and description of MTM to

take to the Board of Healing Arts.• How does the language affect current

practice in and out of hospitals?• How can we incorporate P&T committees

and Medical Staff approval?

Healthy Missourians 2020 Committee

• Senate Resolution 303Established a committee responsible for developing a long-term strategy and plan to improve the health of Missouri residents through engagement of employers, hospitals, physicians, insurance companies, and the federal government.

www.morx.com/healthymo2020

Filling the Care Gap

Pharmacists not readily recognized as “care providers” (Models)

Limited rigorous research to provide evidence of impact (Communications) (“Promising Practice”)

Adequate compensation, or inclusion in service mix (Payment)

Source: Joint Commission of Pharmacy Practioners, 2004

Barriers to Pharmacist Care

Missouri Pharmacist Care Network

Patient-centered. Advocates in Medicine.

A patient-centered provider network designed to enhance the quality of care and quality of life for individuals with chronic disease and complex medication needs through increased access to the skills of a pharmacist.

Bringing together all stakeholdersAcademic

Partnerships Alignment with Payers

Outcomes and

Sustainability

Technologies and Support Clinical Program

Design

Training And Credentialing

Care Management Programming

Contact Information• Nancy Konieczny RPh, MBA   nak5417@bjc.org

Pharmacy Director, Christian Hospital

• Greg Teale Pharm.D. gateale@saint-lukes.orgPharmacy Operations ManagerSaint Luke’s East Hospital

Christine Swyres cms8937@bjc.orgPharmacy ManagerBarnes-Jewish Hospital

• Christian Tadrus, Pharm.D. christian@tadrus.netSam’s Health Mart Pharmacies