[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3108 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3108

 To amend part D of title XVIII of the Social Security Act to promote 
 medication therapy management under the Medicare part D prescription 
                             drug program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 26, 2009

   Mr. Ross introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend part D of title XVIII of the Social Security Act to promote 
 medication therapy management under the Medicare part D prescription 
                             drug program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medication Therapy Management 
Benefits Act of 2009''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Medications are important to the management of chronic 
        diseases that require long-term or lifelong therapy. 
        Pharmacists are uniquely qualified as medication experts to 
        work with patients to manage their medications and chronic 
        conditions and play a key role in helping patients take their 
        medications as prescribed.
            (2) Nonadherence with medications is a significant problem. 
        According to a report by the World Health Organization, in 
        developed countries, only 50 percent of patients with chronic 
        diseases adhere to medication therapies. For example, in the 
        United States only 51 percent of patients taking blood pressure 
        medications are adherent; similarly, only 40 to 70 percent of 
        patients taking antidepressant medications adhere to prescribed 
        therapies.
            (3) Failure to take medications as prescribed costs over 
        $177 billion dollars annually. The problem of nonadherence is 
        particularly important for patients with chronic diseases that 
        require use of medications; poor adherence leads to unnecessary 
        disease progression, reduced functional status, lower quality 
        of life, and premature death.
            (4) When patients adhere to, or comply with, their 
        medication therapy, it is possible to reduce higher-cost 
        medical attention, such as emergency department visits and 
        catastrophic care, and avoid the preventable human costs that 
        impact patients and those who care for them.
            (5) Studies have clearly demonstrated that community-based 
        medication therapy management (MTM) services provided by 
        pharmacists improve health care outcomes and reduce spending. 
        For example, the Asheville Project--a diabetes program designed 
        for city employees in Asheville, North Carolina, and delivered 
        by community pharmacists--resulted over a 5-year period in a 
        decrease in total direct medical costs ranging from $1,622 to 
        $3,356 per patient per year, a 50 percent decrease in the use 
        of sick days, and an increase in productivity accounting for an 
        estimated savings of $18,000 annually. Another project 
        involving pharmacist-provided care to patients with high 
        cholesterol increased compliance with medication to 90 percent 
        from a national average of 40 percent. In North Carolina, the 
        ChecKmeds NC program, which offers eligible seniors one-on-one 
        MTM consultations with pharmacists, saved an estimated 
        $10,000,000 in healthcare costs and avoided numerous health 
        problems in the first year of the program for the more than 
        15,000 seniors receiving MTM. Similar results have been 
        achieved in several other demonstrations using community 
        pharmacists.
            (6) Therefore, enhancement of the MTM benefit under part D 
        of the Medicare program should be a key component of the 
        national health care reform agenda.

SEC. 3. IMPROVEMENT IN PART D MEDICATION THERAPY MANAGEMENT (MTM) 
              PROGRAMS.

    (a) In General.--Section 1860D-4(c)(2) of the Social Security Act 
(42 U.S.C. 1395w-104(c)(2)) is amended--
            (1) by redesignating subparagraphs (C) through (E) as 
        subparagraphs (F) through (H), respectively; and
            (2) by inserting after subparagraph (B) the following new 
        subparagraph:
                    ``(C) Required reviews and interventions.--
                Beginning in the first plan year after the date of the 
                enactment of the Medication Therapy Management Benefits 
                Act of 2009, PDP sponsors shall offer medication 
                therapy management services to targeted beneficiaries 
                described in subparagraph (A)(ii) that include, at a 
                minimum, the following to increase adherence to 
                prescription medications:
                            ``(i) An annual comprehensive medication 
                        review furnished person-to-person by a licensed 
                        pharmacist. The comprehensive medication 
                        review--
                                    ``(I) shall include a review of the 
                                individual's medications, creation of a 
                                personal medication record, and a 
                                recommended medication action plan in 
                                consultation with the individual and 
                                the prescriber; and
                                    ``(II) shall include providing the 
                                patient with a written or printed 
                                summary.
                            ``(ii) Targeted medication reviews 
                        furnished person-to-person by a licensed 
                        pharmacist offered no less frequently than once 
                        every quarter to assess medication use since 
                        the last annual comprehensive medication 
                        review, to monitor unresolved issues, to 
                        identify problems with new drug therapies or if 
                        the individual has experienced a transition in 
                        care.
                            ``(iii) Followup interventions, which may 
                        be provided person-to-person or through other 
                        interactive means, on a schedule and frequency 
                        recommended by the prescriber or a licensed 
                        pharmacist.''.
    (b) Increase Availability of MTM Services to Beneficiaries and 
Increase Community Pharmacy Involvement in Provision of MTM Services.--
            (1) Increased beneficiary access to mtm services.--Section 
        1860D-4(c)(2) of such Act (42 U.S.C. 1395w-104(c)(2)), as 
        amended by subsection (a), is further amended--
                    (A) in subparagraph (A)(ii)(I), by inserting before 
                the semicolon at the end the following: ``or any 
                chronic disease that accounts for high spending in the 
                Medicare program including diabetes, hypertension, 
                heart failure, dyslipidemia, respiratory disease (such 
                as asthma, chronic obstructive pulmonary disease or 
                chronic lung disorders), bone disease-arthritis (such 
                as osteoporosis and osteoarthritis), rheumatoid 
                arthritis, and mental health (such as depression, 
                schizophrenia, or bipolar disorder)'';
                    (B) by adding at the end of subparagraph (A) the 
                following new clause:
                            ``(iii) Identification of individuals who 
                        may benefit from medication therapy 
                        management.--The PDP sponsor shall identify a 
                        process subject to the Secretary's approval 
                        that allows pharmacists or other qualified 
                        providers to identify enrollees for medication 
                        therapy management interventions where such 
                        individuals are not described as targeted 
                        beneficiaries under clause (ii) or are not 
                        otherwise offered services described in 
                        paragraph (C).''; and
                    (C) by inserting after subparagraph (C) the 
                following new subparagraph:
                    ``(D) Medication reviews for dual eligibles and 
                enrollees in transition of care.--Without regard to 
                whether an enrollee is a targeted beneficiary described 
                in subparagraph (A)(ii), the medication therapy 
                management program under this program shall offer--
                            ``(i) a comprehensive medication review 
                        described in subparagraph (C)(i) at the time of 
                        initial enrollment under the plan for an 
                        enrollee who is a full-benefit dual eligible 
                        individual (as defined in section 1935(c)(6)); 
                        and
                            ``(ii) a targeted medication review 
                        described in subparagraph (C)(ii) for any 
                        enrollee at the time of transition of care 
                        (such as being discharged from a hospital or 
                        another institutional setting) where new 
                        medications have been introduced to the 
                        individual's therapy.''.
    (c) Community Pharmacy Access.--Section 1840D-4(c)(2) of such Act 
is further amended by inserting after subparagraph (D) the following 
new subparagraph:
                    ``(E) Pharmacy access requirements.--A PDP sponsor 
                shall offer any willing pharmacy in its network the 
                ability to provide medication therapy management 
                services to assure that enrollees have the option of 
                obtaining services under the medication therapy 
                management program from community-based retail 
                pharmacies.''.
    (d) Reimbursement and Incentives Based on Performance.--
            (1) Appropriate reimbursement for the provision of mtm 
        services.--Section 1860D-4(c)(2)(H) of such Act, as 
        redesignated by subsection (a), is amended by striking the 
        first sentence and inserting the following: ``The PDP sponsor 
        shall reimburse pharmacists and other entities furnishing 
        medication therapy management services under this paragraph 
        based on the resources used and the time required to provide 
        such services.''.
            (2) Evaluation of performance for payment incentives.--
        Section 1860D-4(c)(2) of such Act (42 U.S.C. 1395w-104(c)(2)) 
        is amended by adding at the end the following new subparagraph:
                    ``(I) Evaluation of performance.--
                            ``(i) Data collection and provider 
                        measures.--Effective beginning in the first 
                        plan year after the date of the enactment of 
                        the Medication Therapy Management Benefits Act 
                        of 2009, the Secretary shall establish measures 
                        and standards for data collection by PDP 
                        sponsors to evaluate performance of pharmacies 
                        and other entities in furnishing medication 
                        therapy management services. Such measures 
                        shall be designed to help assess and improve 
                        overall quality of care, including a reduction 
                        in adverse medication reactions, improvements 
                        in adherence and persistence in chronic 
                        medication use, and a reduction in drug 
                        spending, where appropriate. PDP sponsors shall 
                        also compare outcomes based on the type of 
                        entity offering such services and shall ensure 
                        broader participation of entities that achieve 
                        better outcomes with respect to such services. 
                        The measures established under this clause 
                        shall include measures developed by the 
                        Pharmacy Quality Alliance (PQA) in the case of 
                        pharmacist providers.
                            ``(ii) Continual development and 
                        incorporation of medication therapy management 
                        measures in broader health care outcomes 
                        measures.--The Secretary shall support the 
                        continual development and refinement of 
                        performance measures described in clause (i), 
                        including the incorporation of medication use 
                        measures as part of broader health care 
                        outcomes measures. The Secretary shall work 
                        with state Medicaid programs to incorporate 
                        similar performance-based measures into State-
                        required Drug Use Review programs under title 
                        XIX.
                            ``(iii) Incentive payments.--Beginning with 
                        plan year 2011, pharmacies and other entities 
                        that furnish medication therapy management 
                        services under this part shall be provided (in 
                        a manner specified by the Secretary) with 
                        additional incentive payments based on the 
                        performance of such pharmacies and entities in 
                        meeting the quality measures established under 
                        clause (i). Such payments shall be made from 
                        the Medicare Prescription Drug Account except 
                        that such payments may be made from the Federal 
                        Hospital Insurance Trust Fund or the Federal 
                        Supplemental Medical Insurance Trust Fund if 
                        the Secretary determines, based on data under 
                        this part and parts A and B, that such services 
                        have resulted in a reduction in expenditures 
                        under part A or part B, respectively.''.
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