The queue at the counter isn’t shrinking, the phone is already ringing about a refill, and now a Medication Therapy Management review is due — the kind that needs twenty uninterrupted minutes with a patient’s full attention, not the ninety seconds between fills. Nothing about the review itself is the hard part. Fitting it into the day is.
Here’s what the evidence says about MTM’s hardest barrier — and it isn’t the clinical work.
The same pharmacist, the same day
Community pharmacies fill an average of 217 prescriptions a day, and the number of community pharmacies has been declining under financial and staffing pressure since 2023 (NCPA / Cardinal Health). A Comprehensive Medication Review takes a median of roughly 20 to 31 minutes of focused pharmacist time; a Targeted Medication Review can take nearly as long (Chang et al., J Am Pharm Assoc 2018). Both numbers describe the same person, on the same shift, at the same counter.
Workflow integration is the named barrier — not clinical skill
When pharmacy practice literature lists what actually keeps MTM from working well, the clinical competence to deliver it isn’t on the list. Business-model friction, care-team integration, workflow integration, patient engagement, and technology adaptation are (Pharmacy Times). Pharmacists already know how to counsel a patient on their medications. The friction is finding twenty uninterrupted minutes inside a shift built around continuous dispensing.
What “fitting it in” looks like today
The dominant MTM platform’s own guidance to pharmacies is telling on its own terms: it recommends scheduling CMRs during natural lulls — “overlap” staffing windows — specifically to reduce disruption to dispensing. That’s vendor guidance, not independent research, and it’s worth reading as an admission from inside the industry: the platform selling MTM workflow tools is itself telling pharmacies to work around the interruption problem, not that the problem doesn’t exist.
Some pharmacies have solved this. Most haven’t
The same time-and-motion research that measured review length also measured program maturity, and the gap between a pharmacy with a built MTM workflow and one that bolts MTM onto an unchanged dispensing operation is large. “Later Maturity” programs were more likely to deliver full CMRs rather than defaulting to shorter TMRs, more likely to receive physician referrals, and more likely to run structured follow-up (Chang et al. 2018). MTM isn’t uniformly disruptive — it’s disruptive specifically where it hasn’t been built into the day’s structure yet, and a large share of community pharmacies are still in that position.
MTM isn’t uniformly disruptive to a pharmacy’s day. It’s disruptive specifically where it hasn’t been built into the day’s structure yet.
The staffing backdrop MTM lands on
None of this happens in a well-rested workplace. 73% of practicing pharmacists describe their workload as “high” or “excessively high” — a 66% increase from a decade earlier (AACP, 2022 National Pharmacist Workforce Study). In late 2023, pharmacists at CVS- and Walgreens-owned pharmacies around Kansas City staged multi-day walkouts protesting understaffing, no lunch breaks, and 14-hour solo shifts; a year later, trade reporting found the underlying staffing problems largely unresolved (NPR; The Beacon). Those walkouts were about dispensing-floor staffing broadly, not MTM specifically — but a scheduled review that needs twenty protected minutes is exactly the kind of task that gets squeezed out first when a pharmacy is already running on a single overstretched pharmacist.
What this does and doesn’t claim
This isn’t a claim that MTM shouldn’t be delivered in-store, or that every pharmacy struggles with it equally — the maturity-gap evidence above says the opposite is true for pharmacies that have built the workflow. It’s also not a claim about ConfirmMyMeds performing or scheduling MTM: this product handles patient medication-list attestation before a visit, a separate workflow, and doesn’t manage MTM encounters, staffing, or scheduling. The narrower point is that the disruption pharmacists describe is a workflow-design problem with documented variation across practices, not an inherent property of the clinical service.
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 pharmacy staffing and MTM workflow in general terms and is not operational or business advice.