A pharmacist finishes a targeted medication review, logs it in the MTM platform, and moves to the next task. The service paid roughly what a fast-food combo meal costs. It also took about as long as the comprehensive review two patients earlier — the one that paid five times as much.
Here’s what the reimbursement math for Medicare Part D’s Medication Therapy Management program actually looks like once real labor cost is counted against it.
There is no single MTM rate — plans set their own
Unlike a Medicare physician fee schedule, MTM has no single CMS-published rate. Federal rule (42 CFR 423.153(d)) requires every Part D plan sponsor to run an MTM program and set its own fees for the pharmacists who deliver it. Most community pharmacies never negotiate with a plan directly — they connect through an MTM platform, historically split between Mirixa and OutcomesMTM until Cardinal Health’s 2019 acquisition merged them into a single vendor (now branded Outcomes), which aggregates opportunities across plans and pays per completed service.
- A Comprehensive Medication Review (CMR) — the deeper, once-a-year service — pays in the neighborhood of $60 per completed review.
- A Targeted Medication Review (TMR) — a narrower, more frequent check on specific drugs or problems — pays roughly $10 to $12.
Those figures come from a single community pharmacist’s self-reported rate in trade press, not a published national average (Drug Topics) — because no public national average exists. That’s a structural gap worth naming on its own: pharmacies are being asked to budget staff time around a rate that isn’t published anywhere they can compare it.
What a review actually takes
The best available time-and-motion evidence comes from a study that shadowed pharmacists across two call centers and five community pharmacies:
- Median CMR time ranged from 20.3 to 30.8 minutes depending on how mature the pharmacy’s MTM program was.
- Median TMR time ranged from 12.3 to 31.0 minutes — in less-mature programs, a TMR took nearly as long as a CMR.
(Chang et al., J Am Pharm Assoc 2018)
A TMR can take nearly as long to deliver as a CMR — while paying roughly one-fifth to one-sixth as much.
The math, worked out
Combine that time data with current labor cost and a picture emerges — not a disclosed chain figure, but a reasonable estimate built from public numbers. The U.S. Bureau of Labor Statistics puts median pharmacist pay at $140,910 a year, and pharmacy technician pay at $22.00 an hour. Add the standard ~30% benefits-and-payroll-tax load employers carry on top of wages, and fully-loaded cost comes to roughly $89 an hour for a pharmacist and $28 an hour for a technician (BLS, pharmacists; BLS, pharmacy technicians; BLS, employer compensation costs).
- CMR: about 25 minutes of pharmacist time (the midpoint of the range above) costs roughly $37 in labor — against a $60 payment. A thin but real margin, if the pharmacist handles the whole review solo with no technician prep and no documentation overhead beyond the encounter itself.
- TMR: about 20 minutes of pharmacist time costs roughly $30 — against a $10 to $12 payment. A clear per-unit loss under the same solo-pharmacist assumption.
No chain publishes its actual internal cost per review, so this is a model built from two independent public sources — a 2013–2015 academic time study and current wage data — not a disclosed corporate number. Treat it as directional, not audited.
Why chains keep investing anyway
The per-encounter math alone wouldn’t explain why large chains still staff for MTM. The rest of the answer is a second, indirect revenue channel: MTM completion feeds directly into the CMS Star Rating quality measures that determine a pharmacy’s exposure to retroactive DIR (direct and indirect remuneration) fee clawbacks. Improving MTM and Star performance can be worth tens of thousands of dollars a quarter in avoided clawbacks for a pharmacy (Drug Topics) — a bigger lever than the per-review fee itself, and one that doesn’t show up if you only look at the CMR/TMR payment line.
Where the labor-cost gap could close
The clearest lever in the cost model above is who does the work. Pharmacy practice — and the same delegation logic this product’s own Pharmacist/Technician Workflow Addendum draws for medication-list review — separates two kinds of task: gathering and organizing information, which a trained technician can do, and exercising clinical judgment, which requires a pharmacist. A pharmacy that has a pharmacist personally pull the medication history, place outreach calls, and do every minute of documentation for a TMR is paying pharmacist-rate labor for work that doesn’t require a pharmacist’s license. Shifting the data-gathering portion to technician time, at roughly a third of the fully-loaded pharmacist rate, is the most direct way to narrow the gap in the math above.
What this does and doesn’t claim
This isn’t a claim that MTM is unprofitable across the board, or that any specific chain loses money on it — the numbers above are a model, not an audit, and margin varies by how a pharmacy staffs the work. It’s also not a claim about ConfirmMyMeds itself: this product does patient medication-list attestation, not MTM service delivery, and it doesn’t generate CMR documentation, Medication Action Plans, or anything used for MTM billing today. The narrower, defensible point is that an accurate, patient-confirmed medication list arriving before the encounter removes some of the data-gathering time that currently gets billed at pharmacist rates — without that being a demonstrated outcome or a billing claim.
ConfirmMyMeds is a working application. It asks the patient to confirm their clinic’s medication list before the appointment — outside the portal, with the bottles in hand — and returns what they confirmed, what they flagged, and what they never started, timestamped and attributed. It never writes to your record; the clinician decides what goes in the chart and what to do about a gap. We have no outcome data and make no claims about adherence or affordability outcomes. We’re looking for clinics to help us learn where it fails.
This article discusses Medicare Part D MTM reimbursement and pharmacy labor cost in general terms, using public data and estimates, and is not financial or billing advice.