Starting an independent MTM business

One of the most common email topics that arrives in my inbox is "how do I start my own independent MTM business?". I've tried to reply to these messages, but there just aren't enough hours in the day to adequately reply to all of them. So I thought that I would share everything that I have done, with the hope that it will help any other pharmacist who is trying to start.


First and foremost, you should apply for your own NPI if don't already have one. This will uniquely identify you as a provider. If you are going to operate your MTM consulting as separate business entity, you will need an NPI for it as well. Note: wait until you have a registered business name before applying for the business NPI.

Which brings up the next thing that I did... I registered my MTM business as an LLC. Once that was done, I applied for the NPI for the MTM business. Why wait until after the business is registered? That way you can make sure that the name is available. For me, my first two choices for a business name were already registered. I want my business name and NPI to be the same.

All of this so far took about a week or two.


Now for the part that we all really want to know about.


How do I get patients for my business?

This is the point where you need to decide what your MTM business focus will be. Are you going to go after the Medicare Part D patients? How about self-pay patients who might be looking to decrease their out of pocket expense? Corporate clients? Who are you trying to help with your MTM services?

Me...My target market is self-insured, small to mid-sized businesses. My thoughts are to get to these patients before they hit retirement age and help improve their health and save their employers on health-care expenses. I want to go on-site to provide my company's services. But this is a tough market to break into because, surprise, companies don't want to do business with individual pharmacists who are not recognized as health care providers by their insurance company.

The APhA is working on getting the legislation in place to get us the recognition, but it's going to take some time. So I have spent the last two years contacting the medical insurance companies in my area, attempting to get my business recognized as a provider within their networks. My thoughts are that if my company is listed as a provider, the small to mid-sized businesses will be more likely to enter into a contract. If nothing else, the employees could seek me out on their own and bill it to their insurance.

It's been tough going. I've done some direct marketing to my target market and have had some meetings and phone calls with benefits directors. But so far no contracts.

As for getting recognition as a provider with the medical insurance companies, the first two years have been rough. I submit provider applications, only to be turned down with "try back in six month" messages. But recently I have had two insurers request additional information about the services that my company provides. This is promising and I will share what happens at a later time.

I have attempted to become an MTM provider for the Medicare D plans that operate in my state. I have contacted every plan in both 2009 and 2010. The plans that respond usually give me the "we provide MTM services with in-house staff" responses. In my state, there is only one plan that will contract with individual pharmaCISTS to provide MTM services. Outcomes Pharmaceutical Health Care provides MTM services to Humana patients in my state. So I have my business set up as an alternate site provider. I am also currently filling out my application to become a provider in the PharmMD network. Until the medical insurers recognize pharmacists as providers, I am getting access to some patients through the Medicare D plans.

As for training and such, I went to the Delivering Medication Therapy Management Services in the Community session at APhA 2010. It reinforced what I was already thinking that I needed to do. I also bought a couple books from the APhA. Nothing earth-shattering there either. But they did have some good stuff. My previous management experience has done more for me than the books with regards to developing a business plan, etc...

There are several companies that have MTM software programs. I have blogged about them previously.

Hopefully this helps answer some of the questions that you have. Please contact me if you have a specific question. Or leave a comment so that others can benefit from or answer your questions. The more information that we share, the better patient care we can deliver.

* * * * *

If my employer (a chain) wanted to provide MTM services, I would embrace it. But I would want compensated above and beyond my regular wage for providing these services. I don't want to see MTM become simply another ploy to get people in the store to buy over-priced dog biscuits. I'm afraid that as chains enter into the MTM arena it will be another area where they expect pharmacists to provide top-notch patient care without providing adequate support.

As pharmacists, we need to be active politically as individuals. Right now we have MTM legislation sitting in two House committees. The bill needs to make it to the House floor, then to the Senate, then to the President. Remember the old I'm just a bill ditty from Saturday morning cartoons? We need to be active to make the bill become a law.

You can follow the bill at the Library of Congress to see where it is in the process. We need to contact the Congressional committee members who hold the future of MTM in their hands.