[Congressional Record Volume 141, Number 207 (Friday, December 22, 1995)]
[Extensions of Remarks]
[Pages E2443-E2444]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E2443]]


  THE MEDICARE MEDICATION EVALUATION AND DISPENSING SYSTEM ACT OF 1995

                                 ______


                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Friday, December 22, 1995

  Mr. STARK. Mr. Speaker, today, I am introducing a bill that, if 
adopted, would dramatically improve the quality of medical care 
received by our Nation's elderly. This legislation instructs the 
Secretary to implement an on-line, prescription drug information 
management program for Medicare beneficiaries. This system, referred to 
as the Medicare Medication Evaluation and Dispensing System [MMEDS], 
would provide the tools and information to beneficiaries and their 
health care providers that are necessary in order to reduce instances 
of adverse drug interactions, over-medication, and other problems 
related to prescription drug use that plague our elderly.


                               background

  The inappropriate use of prescription drugs is a health problem that 
is particularly acute for the elderly. The elderly not only use more 
prescription drugs than any other age group, they are also more likely 
to be taking several drugs at once, increasing the probability of 
adverse drug reactions.
  The General Accounting Office reported in July 1995 that 17.5 percent 
of the almost 30 million noninstitutionalized Medicare recipients 65 or 
older used at least one drug identified as generally unsuitable for 
elderly patients. In a recent study published in the Journal of the 
American Medical Association [JAMA], researchers concluded that nearly 
one in four noninstitutionalized elderly patients take prescription 
drugs that experts regard as generally unsuitable for their age group. 
If other situations were taken into account, such as incorrect dosage 
levels, for example, the number of medicare patients affected by the 
inappropriate use of prescription drugs would far exceed 25 percent.
  The inappropriate use of prescription drugs has not only proven to be 
dangerous to the health of the elderly, it has also proven to be 
expensive. The Food and Drug Administration estimates that the annual 
cost of hospitalizations due to inappropriate prescription drug use is 
$20 billion.
  The concept of using computer-based systems to improve patient care 
is not a new one. Advanced on-line computer technology is currently 
available that permits prescriptions to be screened before they are 
filled in order to identify potential problems. Thirty States currently 
operate automated drug utilization review [DUR] information systems for 
their Medicaid populations. Much of the initial cost--up to 90 
percent--incurred by States to implement these on-line drug utilization 
review systems has been covered by the Federal Government.


                         is it cost effective?

  The General Accounting office has found that automated prospective 
drug utilization review, like that called for in MMEDS, is cost 
effective to implement and to operate. In the State of Tennessee, a 
reduction of over $4 million in Medicaid drug costs was seen in just a 
6-month period, representing 3.9 percent of the total cost of claims 
processed. In Maryland, over 7,000 prescription doses considered 
excessive for elderly Medicaid patients were modified, resulting in 
$385,252 in savings in just 10 months, and a total of $6.7 million in 
claims were reversed as a result of their on-line MMEDS-like system, 
accounting for 7.1 percent of the cost of Medicaid claims processed 
overall. There is no doubt that if Congress acts to approve this bill, 
the taxpayer's investment will not be lost and Medicare beneficiaries 
will be healthier as a result.


                                 goals

  The goal of this legislation is to provide a comprehensive outpatient 
prescription drug information system available to all Medicare 
beneficiaries which educates physicians, patients, and pharmacists 
concerning: First, instances or patterns of unnecessary or 
inappropriate prescribing and dispensing practices; Second, instances 
or patterns of substandard care with respect to such drugs; Third, 
potential adverse reactions and interactions; and Fourth, appropriate 
use of generic products.


                                program

  The Medicare Medication Evaluation and Dispensing System will build 
on the existing Medicaid infrastructure. MMEDS will give all Medicare 
beneficiaries and their health care providers the medication management 
tools they need to identify the direct threats posed by inappropriate 
medication. In the process, hospital and other medical costs otherwise 
picked-up by Medicare as a result of these adverse reactions will be 
reduced.
  The program would provide on-line, real-time prospective review of 
drug therapy before each prescription is filled or delivered to an 
individual receiving benefits under Medicare. The review by a 
pharmacist would include screening for potential drug therapy problems 
due to therapeutic duplication, drug-drug interactions, and incorrect 
drug dosage or duration of drug treatment.


       Assuring Appropriate Prescribing and Dispensing Practices

  While the MMEDS system will be operated under contract with private 
entities, the Secretary of DHHS would be responsible for overseeing the 
development of the program to assure appropriate prescribing and 
dispensing practices for Medicare beneficiaries. The program would 
provide for prospective review of prescriptions, retrospective review 
of prescriptions filled, and standards for counseling individuals 
receiving prescription drugs. The program would include any elements of 
the State drug use review programs required under Section 1927 of the 
Social Security Act that the Secretary determines to be appropriate.
  As part of the prospective drug use review, any participating 
pharmacy that dispenses a prescription drug to a Medicare beneficiary 
would be required to offer to discuss with each individual receiving 
benefits, or the cargiver of such individual--in person, whenever 
practicable, or through access to a toll-free telephone service--
information regarding the appropriate use of a drug, potential 
interactions between the drug and other drugs dispensed to the 
individual, and other matters established by the Secretary.
  The Secretary would be required to study the feasibility and 
desirability of requiring patient diagnosis codes on prescriptions, and 
the feasibility of expanding prospective drug utilization review to 
include the identification of drug-disease contraindications, 
interactions with over-the-counter drugs, identification of drugs 
subject to misuse or inappropriate use, and drug-allergy interactions.
  The Secretary, directly or through subcontract, would provide for an 
educational outreach program to educate physicians and pharmacists on 
common drug therapy problems. The Secretary would provide written, oral 
or face-to-face communication which furnishes information and suggested 
changes in prescribing and dispensing practices.
  In addition, the Secretary is instructed to, directly or through 
contract, disseminate a consumer guide to assist beneficiaries in 
reducing their expenditures for outpatient drugs and to assist 
providers in determining the cost-effectiveness of such drugs.


                         Pharmacy Participation

  Participation by pharmacies would be on a voluntary basis. 
Participating would be required to meet standards of participation 
including, but not limited to maintenance of patient records, 
information submission at point-of-sale, patient counseling, and 
performance of required drug utilization review activities. 
Participating pharmacies would be required to obtain supplier numbers 
from the Secretary. Such supplier numbers would only be provided to 
pharmacies that meet requirements specified by the Secretary. 
Beneficiaries would be notified of which pharmacies are designated 
Medicare participating pharmacies.


                          payment of services

  Within a 2-year period after the initial operation of the MMEDS 
system, the Secretary would be required to submit to Congress an 
analysis of the effect of the MMEDS on expenditures under the Medicare 
Program and recommended, in consultation with actively practicing 
pharmacists, a payment methodology for professional services provided 
to Medicare beneficiaries. The payment methodology would be designed in 
a manner that generates no net additional costs to the Medicare 
Program, after accounting for the savings to Medicare as a result of 
demonstrable reductions in the inappropriate use of outpatient 
prescription services. The Secretary would submit a report to Congress 
regarding such recommendations as the Secretary determines appropriate.


                  privacy of prescription information

  Standards would be established to maintain the privacy of protected 
health information. Protected health information means any information 
collected in any form under this provision that identifies an 
individual and is related 

[[Page E2444]]
to the physical or mental health of the individual, or is related to 
payment for the provision of health care to the individual.


                               Conclusion

  As the number of elderly in our society increases, the number and 
proportion of drugs used by these older Americans will also increases. 
It is true that drugs, when used appropriately, can reduce or eliminate 
the need for surgical and hospital care, prevent premature deaths, and 
improve quality of life. Unfortunately, a good deal of drug use among 
older persons is inappropriate, often resulting in hospitalization. 
While some drug-related hospital admissions are unavoidable, many can 
be attributed to errors in prescribing. By implementing the Medicare 
Medication Evaluation and Dispensing System Act, we could greatly 
improve the quality of care received by our Nation's elderly. I look 
forward to receiving any comments and feedback from interested parties.

                          ____________________