[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 3454 Introduced in Senate (IS)]

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114th CONGRESS
  2d Session
                                S. 3454

                    To improve medication adherence.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 28, 2016

Mr. Carper (for himself and Mr. Roberts) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
                    To improve medication adherence.

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

SECTION 1. FINDINGS.

    Congress makes the following findings:
            (1) Eighty to ninety percent of the means by which we 
        prevent and control chronic disease is with medications. 
        Assuring the most appropriate and effective medications are 
        used to optimize patient outcomes is a national priority. The 
        ability of patients to then adhere to the medication regimen 
        becomes vital.
            (2) Between \1/2\ and \2/3\ of individuals with chronic 
        diseases in the United States do not take medications as 
        prescribed.
            (3) Suboptimal medication use, including untreated 
        indications (such as failure to immunize), over or under dosing 
        of medications, safety issues, and low rates of medication 
        adherence result in higher health care costs, reduced 
        effectiveness of health care treatments and regimes, negative 
        health effects for patients, and tens of thousands of deaths on 
        an annual basis.
            (4) Appropriate medication use and adherence may be lowest 
        among individuals with chronic diseases.
            (5) Improving medication adherence would reduce unnecessary 
        hospital admissions and emergency room visits.
            (6) Drug therapy problems including underuse and 
        nonadherence is estimated to cost the healthcare system in the 
        United States over $290,000,000,000 each year.
            (7) Improving appropriate medication adherence could 
        improve patient health outcomes, reduce health care costs, and 
        lead to productivity gains.

SEC. 2. NATIONAL RESEARCH AND REPORTING STRATEGY FOR IMPROVED 
              MEDICATION ADHERENCE.

    Part A of title III of the Public Health Service Act (42 U.S.C. 341 
et seq.) is amended by adding at the end the following:

``SEC. 310B. NATIONAL RESEARCH AND REPORTING STRATEGY FOR IMPROVED 
              MEDICATION ADHERENCE.

    ``(a) In General.--The Secretary, in coordination with the 
Administrator of the Agency for Healthcare Research and Quality, the 
Administrator of the Centers for Medicare & Medicaid Services, and the 
Director of the Centers for Disease Control and Prevention, shall 
report annual statistics on medication adherence, particularly with 
respect to individuals with chronic diseases such as cardiovascular 
disease, hypertension, diabetes, autoimmune diseases, chronic 
obstructive pulmonary disease, and mental health conditions, to better 
inform decisionmakers regarding--
            ``(1) primary nonadherence, including among patients newly 
        prescribed one or more medications at the time of discharge 
        from an acute care setting;
            ``(2) medication persistence;
            ``(3) related quality measures with respect to medication 
        and methods to improve medication adherence and medication 
        persistence; and
            ``(4) the strategies used by private stakeholders to 
        improve medication adherence among individuals with one or more 
        chronic illnesses.
    ``(b) Federal Health Care Programs.--The research conducted, and 
information and statistics developed, under subsection (a) (other than 
paragraph (6) of such subsection) shall be with respect to individuals 
treated under the following health care programs:
            ``(1) The Medicare program under title XVIII of the Social 
        Security Act.
            ``(2) The Medicaid program under title XIX of the Social 
        Security Act.
            ``(3) The Federal Employees Health Benefits Plan under 
        chapter 89 of title 5, United States Code.
            ``(4) The TRICARE program under chapter 55 of title 10, 
        United States Code.
            ``(5) Hospital care and medical services furnished by the 
        Department of Veterans Affairs under chapters 17 and 18 of 
        title 38, United States Code.
    ``(c) Definitions.--In this section:
            ``(1) The term `medication adherence' means a patient 
        taking medications as prescribed by their health care provider, 
        which may include the prescribed dosage, time, frequency, and 
        direction.
            ``(2) The term `medication persistence' means the act of 
        continuing treatment with a medication for the prescribed 
        duration.
            ``(3) The term `primary nonadherence' means the failure to 
        fill a newly prescribed medication.
            ``(4) The term `medication management' means medical care 
        provided by a health care professional to optimize drug therapy 
        and improve therapeutic outcomes for patients, including 
        medication therapy management.
    ``(d) Reports to Congress.--The Secretary shall submit to Congress 
an initial report on the research conducted under this section not 
later than 1 year after the date of enactment of this section, and an 
updated report not later than 5 years after submission of such initial 
report.''.

SEC. 3. LINKING MEDICARE PRESCRIPTION DRUG AND PARTS A AND B CLAIMS 
              DATA.

    Section 1860D-4(c) of the Social Security Act (42 U.S.C. 1395w-
104(c)) is amended by adding at the end the following new paragraph:
            ``(5) Linking prescription drug and parts a and b claims 
        data.--
                    ``(A) In general.--Notwithstanding any other 
                provision of law, subject to subparagraph (B), 
                effective for plan year 2018 and each subsequent plan 
                year, the Secretary shall, upon request by the PDP 
                sponsor of a prescription drug plan, provide the plan 
                with enrollee claims data under parts A and B, in order 
                to enable the plan to see the items and services 
                furnished to an enrollee under such parts and to 
                provide greater context for the medication regimen of 
                the enrollee.
                    ``(B) Requirements.--The data described in 
                subparagraph (A) shall, as determined by the Secretary, 
                be provided to a prescription drug plan on a regular 
                basis and in a format that is computable and accessible 
                to assist plan efforts in identifying and supporting 
                at-risk enrollees.''.

SEC. 4. RECOGNIZING MEDICATION MANAGEMENT IMPROVES QUALITY UNDER 
              MEDICARE ADVANTAGE AND PRESCRIPTION DRUG PLANS.

    Section 1857(e) of the Social Security Act is amended--
            (1) in paragraph (4), by striking ``If the Secretary'' and 
        inserting ``Subject to paragraph (5), if the Secretary''; and
            (2) by adding at the end the following new paragraph:
            ``(5) Recognizing medication management improves quality.--
        For purposes of calculating the minimum medical loss ratio 
        under paragraph (4) for a contract year (beginning with 2018), 
        the Secretary shall include medication management (as defined 
        in section 310B(c) of the Public Health Service Act) as part of 
        activities that improve health care quality (as described with 
        respect to Medicare Advantage plans and prescription drug plans 
        in sections 422.2430 and 423.2430, respectively, of title 42, 
        Code of Federal Regulations (or in any successor 
        regulation)).''.

SEC. 5. ENHANCED MEDICATION THERAPY MANAGEMENT MODEL FOR MA-PD PLANS.

    Section 1115A(b)(2) of the Social Security Act (42 U.S.C. 
1315a(b)(2)) is amended--
            (1) in subparagraph (A), by adding at the end the following 
        new sentence: ``The models selected under this subparagraph 
        shall include the model described in subparagraph (D), which 
        shall be implemented by not later than the date that is 1 year 
        after the implementation of the Part D Enhanced Medication 
        Therapy Management Model, as conducted by the Centers for 
        Medicare & Medicaid Services with respect to stand-alone basic 
        prescription drug plans.''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Enhanced medication therapy management for 
                ma-pd plans.--
                            ``(i) In general.--Subject to clause (ii), 
                        the model described in this subparagraph is a 
                        model to test, with respect to MA-PD plans (as 
                        defined in section 1860D-1(a)(3)(C)), a model 
                        for enhanced medication therapy management that 
                        is similar to the Part D Enhanced Medication 
                        Therapy Management Model, as conducted by the 
                        Centers for Medicare & Medicaid Services with 
                        respect to stand-alone basic prescription drug 
                        plans.
                            ``(ii) No additional performance payment.--
                        Under the model described in this subparagraph, 
                        an MA-PD plan (as so defined) shall not receive 
                        any additional performance payment (other than 
                        any applicable percentage quality increase 
                        otherwise applicable for the plan under section 
                        1853(o)).''.
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