As a pharmacy owner, you’re on the front lines. You see the patients with multiple chronic conditions, the “shopping bags” full of prescriptions from different doctors, and the genuine confusion in their eyes. You have the clinical knowledge to intervene, optimize their therapy, and prevent costly hospital visits.

But for decades, our system has only paid us to “count and pour.”

I’ve been there, looking at the razor-thin margins on the dispensing side, knowing my expertise was being given away for free during counseling. Medication Therapy Management (MTM) is the answer.

It’s not just another clinical “to-do.” It’s a structured, billable framework that allows you to diversify your revenue, deliver high-impact care, and prove your value in the healthcare system. But where do you even start?

Let’s be honest, the idea of adding one more thing to your workflow can be overwhelming. This guide breaks it down into five practical, manageable steps, from a pharmacist-owner’s perspective.

What Is MTM (And What Is It Not)?

First, let’s clear up a misconception. MTM in pharmacy is not just a longer counseling session. It’s a distinct set of services designed to optimize therapeutic outcomes for patients.

The “core” pharmacy MTM services include:

1. Comprehensive Medication Review (CMR): A systematic, in-depth review of a patient’s entire medication profile (Rx, OTC, supplements) to identify and resolve medication-related problems.
2. Targeted Medication Review (TMR): A focused review to address a specific problem, like poor adherence or a high-risk medication.

This is not just “good practice”—it’s a billable clinical service. It’s one of the most powerful tools we have to unlock new revenue, which we cover in our guide, Beyond the Counter: A Pharmacist’s Guide to Launching New Revenue Streams.

Step 1: How to Recruit MTM Patients (Without Feeling “Salesy”)

This is the biggest hurdle for most pharmacists. We’re clinicians, not salespeople. The good news is, you don’t have to “sell” MTM. You just have to offer the solution to a problem your patients already have.

Tactic 1: The “Givens” (MTM Platforms)

The easiest place to start is with the MTM platforms you’re likely already contracted with, like Outcomes, Mirixa, or Med-Monitor. These platforms literally hand you a list of eligible patients who have been flagged by their insurance (often Medicare Part D) for a CMR.

• Action: Dedicate one hour, one day a week, to only review your MTM platform queues and identify eligible patients.

Tactic 2: Your “Home-Grown” Data

Your most high-need patients are already in your system. You just have to find them. Run reports in your pharmacy management system for:

• Patients with 8 or more chronic medications.
• Patients on 3 or more high-risk medications (e.g., anticoagulants, insulin, opioids).
• Patients with poor adherence (a refill history full of gaps) for conditions like diabetes, COPD, or hypertension.

Tactic 3: The “Warm” Offer at the Counter

When you see one of these patients at the counter, use an empathetic, problem-solving script.

• Instead of: “Do you want an MTM?”
• Try This: “Mrs. Jones, I was reviewing your file and I see you’re on medications from three different doctors. I know it can be a lot to keep track of. I offer a service, covered by your insurance, where we can sit down together for 30 minutes to create a single, simple plan for all of your medications. Would that be helpful?”

Step 2: How to Deliver the MTM Service (Efficiently)

Your workflow is everything. If you try to do a 30-minute CMR at the drive-thru window, you will fail.

1. Schedule It Like a Doctor’s Visit. This is the most important rule. Schedule MTM appointments just like you would a flu shot clinic. This creates protected time for you and signals the value of the service to the patient.
2. Create a Dedicated Space. It doesn’t have to be a separate office. A semi-private consultation window or a quiet corner of the pharmacy works perfectly. The goal is to minimize interruptions and protect patient privacy.
3. Use a Standardized Process. Don’t reinvent the wheel every time. Have your CMR form ready (APhA has great templates). The goal of the 20-30 minute meeting is to:
   • Review every medication (Rx, OTC, herbs).
   • Identify problems (e.g., “Are you still taking this one?” “Are you having this side effect?”).
   • Resolve problems (e.g., “Let’s call your doctor about that duplicate therapy.”).
4. Provide the Deliverables. At the end of the CMR, the patient must leave with two documents:
   • Personal Medication List (PML): A simple, updated list of all their medications.
   • Medication Action Plan (MAP): A “to-do” list for the patient (e.g., “1. Take this pill with food. 2. Call Dr. Smith for a follow-up.”).

Step 3: How to Bill and Get Paid for Your Time

You did the clinical work. Now, you must get paid for it. This is where most pharmacies get stuck.

Path 1: Billing MTM Platforms

This is the simplest path. When you complete a CMR for a patient flagged by Outcomes or Mirixa, you document and bill the service directly through their portal. They provide the CPT codes and billing instructions.

Path 2: Billing Medical Insurance Directly (The Real Goal)

What about the high-risk patients you identified yourself? This is where medical billing comes in. You can bill payers (like Medicare Part B and private insurers) using a standard CMS-1500 claim form.

The primary CPT codes for MTM for pharmacists are:

• 99605: For the first 15 minutes of a new patient MTM service.
• 99606: For the first 15 minutes of an established patient.
• 99607: An “add-on” code for each additional 15 minutes.

This means a 30-minute CMR for an established patient would be billed with 99606 + 99607.

A Pharmacist’s Perspective: Using these codes is a game-changer. But be warned: you can’t just send a claim and hope for the best. You must be credentialed as a provider and follow all the rules of medical billing. This is a complex process, which is why we created our Pharmacist-Owner’s Guide to Medical Billing to walk you through it.

Step 4: How to Track Your Impact (To Prove Your Worth)

How do you know your MTM program is working? You track your mtm outcomes. This isn’t just about revenue; it’s about the clinical and economic value you create.

For every MTM encounter, you should track:

• Clinical Interventions: “Duplicate therapy stopped,” “Adverse effect identified,” “Adherence barrier removed.”
• Patient Outcomes: “A1c lowered by 1%,” “Blood pressure at goal.”
• Economic Outcomes: “Switched to lower-cost generic,” “Unnecessary medication stopped,” “ER visit prevented.”

This data is gold. It’s what you use to show patients, doctors, and even payers the tangible value your medication therapy management program provides.

Step 5: How to Scale Your MTM Program

You can’t do it all yourself. A successful pharmacy MTM program is a team effort.

• Train Your Techs: Your technicians are your greatest asset. Train them to identify eligible patients, run the reports, handle the scheduling, and gather the initial medication history. This frees you up to focus only on the clinical review and consultation.
• Block Your Time: Get a high-volume scheduler. Block off two afternoons a week only for clinical services. Protect that time fiercely.
• Automate Your Billing: As you scale, you can’t be chasing down individual rejections. This is where a dedicated billing partner (like RxBB) becomes essential. You do the care; we handle the claims, denials, and follow-up to ensure you get paid.

It’s a Marathon, Not a Sprint

Launching an MTM service won’t transform your business overnight. It takes time to build the workflow, train your team, and market the service.

But it is the single most important step you can take toward a more sustainable, profitable, and professionally satisfying future. You’re finally getting paid for the expertise you’ve always had. You’re diversifying your revenue away from the PBMs. And you’re delivering the high-level patient care that inspired you to become a pharmacist in the first place.