Medication therapy management favors large pharmacy chains and creates potential conflicts of interest.

We hypothesize that recent changes in policy and the spread of in-store medical clinics favor the provision of medication therapy management (MTM) services by large chain pharmacies while creating the potential for conflicts of interest from employed prescribers. First, MTM is now required by Medicare Part D, but the program may be more practical for community pharmacy chains than independent pharmacies. Second, in-store clinics have proliferated, which may accommodate the provision of MTM services in these community locations. Third, while physician ownership of pharmacies is restricted, the law has not anticipated the in-store clinic situations in which the pharmacy employs a prescriber on-site.