Class of 2012 Abstract / Specific Aims: To assess physician approval of the MTM services provided. Specifically, to compare cost saving, guideline adherence, and safety concern interventions. Methods: A retrospective analysis of pharmacist interventions was performed using the MMC database for 2008. Data were collected on the type of intervention and approval by physicians. Physician specialty was also collected from state medical boards. Descriptive statistics were used to generate frequencies of approvals. Chi-square tests were used to compare physician approval by intervention type. Main Results: Pharmacists initiated 1,563 interventions that were faxed to physicians for approval. Of these interventions, cost saving, guideline adherence, and safety concerns were 33.2, 58.3, and 8.5 percent, respectively. Interventions primarily targeted diabetes (38.6%), cardiovascular disease (28.8%), gastroesophageal reflux disease (13.1%), and respiratory disease (8.4%). Physician approval for cost saving, guideline adherence, and safety concerns were 58.0, 44.4, and 41.0 percent, respectively. Approval for cost saving was greater than guideline adherence (58.0% versus 41.0%, P<0.001) and safety concerns (58.0% versus 44.4%, P=0.005). Approval among primary care physicians (PCP) compared to specialty physicians was greater for both cost saving (60.6% versus 50.7%, P=0.046) and guideline adherence (43.2% versus 36.2%, P=0.045) interventions. Conclusions: Results of this investigation provide evidence that there are differences in the types of MTM interventions that physicians will approve. In an effort to improve patient outcomes, this finding suggests a potential to increase overall physician approval of pharmacist-initiated MTM interventions in the areas of guideline adherence and safety concerns. Results further suggest that lower approval by specialists compared to PCPs may call for alternative methods to better reach these providers.