[Congressional Record Volume 156, Number 99 (Tuesday, June 29, 2010)]
[Senate]
[Pages S5539-S5540]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. HAGAN (for herself and Mr. Franken):
  S. 3543. A bill to amend title XVIII of the Social Security Act to 
expand access to medication therapy management services under the 
Medicare prescription drug program; to the Committee on Finance.
  Mrs. HAGAN. Mr. President, today, I am proud to introduce the 
Medication Therapy Management, MTM, Expanded Benefits Act of 2010, with 
my colleague from Minnesota, Senator Franken.
  A recent analysis conducted by the New England Healthcare Institute 
estimates that the overall cost of medication nonadherence is as much 
as $290 billion per year. According to a recent article published in 
the New England Journal of Medicine, over $100 billion is spent 
annually on avoidable hospitalizations because patients do not take 
their medications correctly.
  Not only does nonadherence cost our system billions of dollars, 
nonadherence to medication regimens also affects the quality of life 
for seniors and may lead to early death. The elderly typically take 
many more prescription medicines than the general population and 
therefore are at greater risk for problems associated with improper use 
of medications. For example, the same New England Journal of Medicine 
article I just reference found that better adherence to 
antihypertensive treatment alone could prevent 89,000 premature deaths 
in the U.S. annually.
  With as much as one half of all patients in the U.S. not following 
their doctors' orders regarding their medications, medication therapy 
management could help reduce some of the wasted health care costs in 
our system.
  North Carolina has implemented some very successful MTM programs.
  The Asheville Project, which focuses on diabetes, asthma, and 
cardiovascular disease, has seen improved health outcomes and 
significant savings among city employees since it began in 1997. For 
example, in the Asheville Project's diabetes MTM Project, they have 
seen a decrease in medical costs of between $1,622 to $3,356 per 
patient per year; a decrease in insurance claims of $2,704 per patient 
in year 1 and a $6,502 decrease in year 5; a 50 percent decrease in use 
of sick days; and increased productivity gains estimated at $18,000 
annually.
  In 2007, the North Carolina Health and Wellness Trust Fund Commission 
launched an innovative statewide program, Checkmeds NC, to provide MTM 
services to North Carolina seniors. During the program's first year, 
more than 15,000 North Carolina seniors and 285 pharmacists 
participated. The seniors bring all of their prescriptions, over-the-
counter medicines, vitamins and supplements to the pharmacy to be 
thoroughly reviewed in a one-on-one session. The pharmacist follows up 
and educates the patient about his or her medication regimen. The 
program saved an estimated $10 million, and countless health problems 
were avoided.
  During consideration of health care reform, I was pleased to have 
successfully secured language in the bill that built off these North 
Carolina models and implemented MTM nationally for seniors suffering 
from two or more chronic conditions.
  The bill I am introducing today takes MTM one step further. 
Specifically, this bill would expand MTM eligibility to seniors with 
any chronic condition that accounts for high spending in our health 
care system, such as heart failure and diabetes. Currently, only 12.9 
percent of Part D beneficiaries are eligible under the MTM criteria for 
multiple chronic conditions. However, of those, more than 85 percent 
have chosen to participate in the benefit. Clearly this program is very 
popular and widely utilized by those who are already eligible. By 
expanding eligibility to more seniors, MTM will certainly result in 
Medicare savings.
  The bill also ensures access to MTM for seniors at a pharmacy or with 
a qualified health care provider of their choice.
  To ensure pharmacists and health care providers are able to provide 
MTM to seniors, this bill ensures they are appropriately reimbursed for 
their time and service. This provision will permit pharmacies and other 
health care providers to spend considerable time and resources 
evaluating a person's drug routine and educating them on proper usage--
all critical components of a successful MTM program.
  Finally, this bill would establish standards for data collection to 
evaluate and improve the Part D MTM benefit.
  The value of MTM is widely known and discussed. I am proud that North 
Carolina is a leader in this arena. Expansion of MTM to more seniors 
will no doubt improve their overall health, while at the same time 
reducing waste in our health care system.
  I urge my colleagues to support this bill.
  Mr. FRANKEN. Mr. President, I am proud today to be joining Senator 
Hagan in introducing the MTM Expanded Benefits Act.
  We all know that prescription drugs are an essential part of health 
care. What a lot of people don't know is that only about 50 percent of 
Americans typically take their medicines as prescribed. This means that 
too often, the benefits of these important therapies aren't fully 
realized. According to a recent article in the New England Journal of 
Medicine, over $100 billion is spent annually on avoidable 
hospitalizations because patients don't take their medications 
correctly.
  The MTM Expanded Benefits Act would help improve the care for seniors 
by increasing access to the medication therapy management benefit--also 
known as MTM--in the Medicare Part D prescription drug program.
  Medication therapy management is a proven set of services that helps 
patients get the best possible results from their medications. MTM 
services are provided by pharmacists who work with patients and their 
health care providers to make sure that seniors are taking medications 
as they should be. Through MTM, patients get focused education to make 
sure they understand their medications--what conditions the drugs treat 
and how to avoid drug interactions that can make medications less 
effective or even dangerous.
  It is not uncommon for a Minnesota senior who has diabetes to be 
taking 10 or more medications that are prescribed by multiple 
providers. But right now under Medicare, you would have to have at 
least four chronic conditions before you would become eligible for MTM. 
That just doesn't make sense to me.
  Under the MTM Expanded Benefits Act, seniors with any chronic 
condition could benefit from MTM. The bill would increase the number of 
people eligible for MTM, helping more seniors to access the life saving 
and money-saving services.
  Congress recognized the value of MTM when it required Medicare Part D 
drug plans to offer the service as part of the Medicare Modernization 
Act of 2003. Furthermore, State Medicaid Programs, including ours in 
Minnesota, use MTM to maximize the value of their pharmacy benefits. As 
we reform our health care system and provide insurance coverage to more 
Americans, it makes sense to ensure that MTM becomes more widely 
adopted throughout our health care system.
  And MTM isn't just good for patient health, it also saves money. A 
University of Minnesota study showed that when patients were able to 
consult with a pharmacist to determine their optimal medication 
regimen, total health expenditures decreased from $11,965 to $8,197 per 
patient. The reduction in total health expenditures exceeded the cost 
of providing MTM services by more than 12 to 1. That is huge.

[[Page S5540]]

  The elderly typically take many more prescription medicines than the 
general population and therefore are at greater risk for problems 
associated with improper use of medications. Improving the Medicare MTM 
benefit will help our Nation's seniors get the most out of their 
medications while also helping to reduce costs through appropriate 
medication use and improved outcomes. I urge my colleagues to support 
the MTM Expanded Benefits Act and help support efforts to improve the 
prescription drug benefit for Medicare beneficiaries.
                                 ______