One of my favorite sayings is “Don’t let perfect be the enemy of the good.” Sometimes when one waits for the perfect opportunity, they miss many wonderful events that just didn’t look so wonderful at first. This desire for perfect conditions can also hold us back professionally, especially when it comes to developing and implementing patient care programs.

Five years ago, pharmacy in Iowa was preparing to implement a new innovative patient care program for its Medicaid population. This program, called Pharmaceutical Case Management (PCM), was the product of many years of intense advocacy and leadership efforts on the part of the Iowa Pharmacy Association and the pharmacy profession in Iowa. Previous years had almost yielded positive results in implementing a professional payment system for pharmacists, and one year it was as close as the then-Governor Branstad’s veto pen. Finally, in the 2000 Legislative Session after years of persistence, a program that reimbursed pharmacists for professional services was born.

People who are just learning about the PCM program today will often raise questions about the genesis of the program parameters. Usually, the first question asked is, why did you call it that? Like many things that enter the legislative process, it looks one way when going in and completely different when coming out. Previous years’ attempts to pass a “pharmaceutical care” program were difficult. The textbook definitions of pharmaceutical care were hard for legislators to understand. In fact, a lack of a clear definition of pharmaceutical care was one of the reasons cited by Governor Branstad in his veto message. When legislators in the 2000 Session asked if pharmaceutical care was like case management but specific to medications, the term “pharmaceutical case management” was born. Necessity is the mother of invention. Clarity was needed for the legislators, and a new term that they could relate to was invented.

Another necessity to success was to garner support, or at least prevent opposition, from the organized medical associations in Iowa. The need to gain this support answers the question “why is it this way?” Parameters related to reimbursement structure, patient eligibility criteria, and pharmacist training requirements were all part of these negotiations. For example, PCM in Iowa Medicaid reimburses both physicians and pharmacists for PCM services, and provides equal payment to both parties. This is clearly not an equitable situation – pharmacists meet and interview with the patient, work up an action plan, and provide ongoing patient monitoring. This work is obviously more intensive than the review of the action plan that is required by physicians. However, when the legislation authorizing the PCM program was passed, a make-or-break issue with organized medicine was that pharmacists and physicians would be reimbursed equally. Hence, the reimbursement model consists of equal payments to both providers.

As I reflect upon those early days of implementing the PCM program in Iowa Medicaid, I am reminded of exactly how far our profession has progressed over the last five years. At that time, pharmacists providing professional services and operations of such a program required vision.   Five years later, medication therapy management services (MTMS) is part of the Medicare Modernization Act of 2003 (MMA) and required for targeted beneficiaries. If one examines the principles and goals of the MTMS language in MMA and compares it to the State Plan Amendment from CMS authorizing PCM in Iowa Medicaid, the striking similarities leads one to believe that these pioneering efforts have expanded far beyond the Iowa borders.

Just as the parameters during PCM implementation were not perfect, neither are the MTMS parameters outlined in the MMA. But it is through these imperfect opportunities that pharmacists will provide the patient care services that improve the health care system and, more importantly, improve the health of patients. As you consider how you will serve your patients, remember that less-than-perfect opportunities can be rewarding beyond your imagination.  Cease the moment and pursue the opportunity!

Click here for more information on the Iowa Pharmaceutical Case Management Program.