When a patient told Sara Dawson, PharmD, during a medication review that she couldn’t afford the $42-a-month blood-pressure medication her doctor had prescribed, Dawson talked to the doctor, made a recommendation for a cheaper substitute, and offered to monitor the patient’s blood pressure for the first two weeks of the new regimen.

It’s the kind of patient-care work the people at Clinic Pharmacy have been doing for decades, but before Dawson got there in 2010, chances were they probably didn’t know they could have gotten reimbursed for those services.

That’s where the training Dawson received during her community pharmacy residency through the UNC Eshelman School of Pharmacy paid off. During her residency at Kerr Drug, she got to work with three different platforms for medication therapy management. She also had the opportunity to provide MTM services not only at the pharmacy where she was based, but also at other Kerr Drug locations that didn’t have clinical pharmacists.

When she became a pharmacist at Clinic Pharmacy, a small independent community pharmacy in Durham, North Carolina, Dawson drew upon her residency experience to design MTM services and educate the pharmacists at the store about what kind of patient-care services they could bill for.

 

“Residency not only teaches you the clinical aspect, but also the business aspect, so you learn how to build a business model around these kinds of different services”

— Sara Dawson, PharmD;
alumna of the School's PharmD and
community pharmacy residency programs

“I think the biggest moment where I realized that the residency training had come into play was when I was educating our pharmacists on what you can bill for under the different MTM platforms and they said, ‘We’ve been doing that for thirty years and never getting paid for it. We can get paid for this now?’ ” says Dawson, who completed her residency after graduating from the School’s PharmD program in 2009.

“I think if I had gone straight into this situation right out of school, I would have had a bigger learning curve in starting these services.”

Dawson doesn’t have to look far for someone who shares those sentiments. Twenty minutes down the road in Morrisville, Katie Zimmerman — Dawson’s friend, former classmate, and fellow resident — has also been expanding the MTM services at Morrisville Pharmacy and Compounding. Like Dawson, Zimmerman has been relying on the MTM training she received during her residency.

“Community pharmacy is shifting away from primarily a drug-dispensing role, so we really need to fill in our revenue gap with patient-care services, and that’s where MTM has really come into play,” says Zimmerman, who moved to Tennessee in the summer of 2011. “I’ve been able to expand some of the MTM services they have here. I’ve also found that MTM opens the door to providing other services as well, such as immunizations or other disease state-specific education. So it’s a good gateway to meeting with patients and getting them to take part in other services as well.

“I feel like my knowledge and expertise from the residency were really valuable when I first started here because I was able to bring those things I had learned and those experiences I had to the pharmacy here.”

The growing emphasis on MTM in community pharmacies has triggered a corresponding emphasis on teaching the subject in pharmacy schools. It has only been a couple years since Dawson and Zimmerman graduated, but in that time, MTM has gone from a new idea that didn’t make it into the curriculum until their third year — and then only as an elective — to being integrated into the pharmaceutical care lab, a key part of UNC’s PharmD curriculum in which students learn skills through hands-on activities and interactions.

“During my residency, I got to teach lab for the second-year students, and they are making MTM a big point of emphasis in the lab situation now, having the students review a patient’s profile and asking what interventions or recommendations they would make,” Dawson says. “In the short time I’ve been out of school, I’ve seen the MTM curriculum really grow at UNC.”

While Dawson and Zimmerman didn’t have the benefit of such a curriculum while they were students, the School’s community pharmacy residency program not only helped fill in the gap, but also equipped them with the knowledge and skills to bring something new to their pharmacies.

“I worked at Clinic Pharmacy while I was in pharmacy school, and I did the residency because I knew that I liked independent pharmacies and I wanted to come back here and work, and I knew the residency would provide me with the kind of training that would allow me to bring new programs into this pharmacy,” Dawson says.

“Residency not only teaches you the clinical aspect, but also the business aspect, so you learn how to build a business model around these kinds of different services.”