II 

112TH CONGRESS 

1ST SESSION S. 274 

To amend title XVIII of the Social Security Act to expand access to medication therapy management services under the Medicare prescription drug 

program. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 3, 2011 

Mrs. HAGAN (for herself, Mr. FRANKEN, Mr. BROWN of Ohio, and Mr. JOHNSON of South Dakota) introduced the following bill; which was read twice 

and referred to the Committee on Finance 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medication Therapy 

5 Management Empowerment Act of 2011’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) Medications are important to the manage9 ment of chronic diseases that require long-term or 


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1 lifelong therapy. Pharmacists are uniquely qualified 

2 as medication experts to work with patients to man3 age their medications and chronic conditions and 

4 play a key role in helping patients take their medica5 tions as prescribed. 

6 (2) Nonadherence with medications is a signifi7 cant problem. According to a report by the World 

8 Health Organization, in developed countries, only 50 

9 percent of patients with chronic diseases adhere to 

10 medication therapies. For example, in the United 

11 States only 51 percent of patients taking blood pres12 sure medications and only 40 to 70 percent of pa13 tients taking antidepressant medications adhere to 

14 prescribed therapies. 

15 (3) Failure to take medications as prescribed 

16 costs over $290,000,000,000 annually. The problem 

17 of nonadherence is particularly important for pa18 tients with chronic diseases that require use of medi19 cations. Poor adherence leads to unnecessary disease 

20 progression, reduced functional status, lower quality 

21 of life, and premature death. 

22 (4) When patients adhere to or comply with 

23 prescribed medication therapy it is possible to reduce 

24 higher-cost medical attention, such as emergency de25 partment visits and catastrophic care, and avoid the 


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1 preventable human costs that impact patients and 

2 the individuals who care for them. 

3 (5) Studies have clearly demonstrated that com4 munity-based medication therapy management serv5 ices provided by pharmacists improve health care 

6 outcomes and reduce spending. 

7 (6) The Asheville Project, a diabetes program 

8 designed for city employees in Asheville, North Caro9 lina, that is delivered by community pharmacists, re10 sulted over a 5-year period in a decrease in total di11 rect medical costs ranging from $1,622 to $3,356 

12 per patient per year, a 50 percent decrease in the 

13 use of sick days, and an increase in productivity ac14 counting for an estimated savings of $18,000 annu15 ally. 

16 (7) Another project involving care provided by 

17 pharmacists to patients with high cholesterol in18 creased compliance with medication to 90 percent 

19 from a national average of 40 percent. 

20 (8) In North Carolina, the ChecKmeds NC pro21 gram, which offers eligible seniors one-on-one medi22 cation therapy management consultations with phar23 macists, has saved an estimated $34,000,000 in 

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1 lems since implementation in 2007 for the more 

2 than 31,000 seniors receiving such consultations. 

3 (9) Results similar to those found under such 

4 projects and programs have been achieved in several 

5 other demonstrations using community pharmacists. 

6 SEC. 3. IMPROVEMENT IN PART D MEDICATION THERAPY 

7 MANAGEMENT PROGRAMS. 

8 (a) INCREASED AVAILABILITY AND COMMUNITY

9 PHARMACY INVOLVEMENT IN THE PROVISION OF MEDI10 CATION THERAPY MANAGEMENT SERVICES.— 

11 (1) INCREASED BENEFICIARY ACCESS TO MEDI12 CATION THERAPY MANAGEMENT SERVICES.—Section 

13 1860D–4(c)(2) of the Social Security Act (42 U.S.C. 

14 1395w–104(c)(2)), as amended by section 10328 of 

15 the Patient Protection and Affordable Care Act 

16 (Public Law 111–148), is amended— 

17 (A) in subparagraph (A)— 

18 (i) in clause (ii)(I), by inserting ‘‘or 

19 any chronic disease that accounts for high 

20 spending in the program under this title, 

21 including diabetes, hypertension, heart fail22 ure, dyslipidemia, respiratory disease (such 

23 as asthma, chronic obstructive pulmonary 

24 disease, or chronic lung disorders), bone 

25 disease-arthritis (such as osteoporosis and 


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1 osteoarthritis), rheumatoid arthritis, and 

2 mental health (such as depression, schizo3 phrenia, or bipolar disorder)’’ before the 

4 semicolon at the end; and 

5 (ii) by adding at the end the following 

6 new clause: 

7 ‘‘(iii) IDENTIFICATION OF INDIVID8 UALS WHO MAY BENEFIT FROM MEDICA9 TION THERAPY MANAGEMENT.—The PDP 

10 sponsor shall, subject to the approval of 

11 the Secretary, establish a process for iden12 tifying individuals who— 

13 ‘‘(I) are not targeted bene14 ficiaries described in clause (ii); 

15 ‘‘(II) are not otherwise offered 

16 medication therapy management serv17 ices; and 

18 ‘‘(III) a pharmacist or other 

19 qualified provider determines may 

20 benefit from medication therapy man21 agement services. 

22 For purposes of this paragraph, any indi23 vidual identified under this clause shall be 

24 treated as a targeted beneficiary described 

25 in clause (ii).’’; 


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1 (B) by redesignating— 

2 (i) subparagraphs (E), (F), and (G), 

3 as redesignated by paragraph (1) of such 

4 section 10328, as subparagraphs (G), (H), 

5 and (I), respectively; and 

6 (ii) subparagraph (E), as added by 

7 paragraph (2) of such section 10328, as 

8 subparagraph (F); and 

9 (C) by inserting after subparagraph (D) 

10 the following new subparagraph: 

11 ‘‘(E) MEDICATION REVIEWS FOR DUAL

12 ELIGIBLES AND ENROLLEES IN TRANSITION OF

13 CARE.—Without regard to whether an enrollee 

14 is a targeted beneficiary described in subpara15 graph (A)(ii), the medication therapy manage16 ment program under this paragraph shall offer 

17 the following: 

18 ‘‘(i) In the case of an enrollee who is 

19 a full-benefit dual eligible individual (as 

20 defined in section 1935(c)(6)), a com21 prehensive medication review described in 

22 subparagraph (C)(i). The review under the 

23 preceding sentence shall be offered at the 

24 time of the initial enrollment of such indi25 vidual in the prescription drug plan. 


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1 ‘‘(ii) In the case of any enrollee who 

2 is experiencing a transition in care (such 

3 as being discharged from a hospital or 

4 other institutional setting), a targeted 

5 medication review described in subpara6 graph (C)(ii) of any new medications that 

7 have been introduced to the enrollee’s ther8 apy. The review under the preceding sen9 tence shall be offered at the time of such 

10 transition.’’. 

11 (2) ACCESS TO MEDICATION MANAGEMENT

12 THERAPY.—Section 1840D–4(c)(2) of such Act (42 

13 U.S.C. 1395w–104(c)(2)) is further amended— 

14 (A) by redesignating— 

15 (i) subparagraphs (G), (H), and (I), 

16 as redesignated by paragraph (1)(B)(i), as 

17 subparagraphs (H), (I), and (J), respec18 tively; and 

19 (ii) subparagraph (F), as redesignated 

20 by paragraph (1)(B)(ii), as subparagraph 

21 (G); and 

22 (B) by inserting after subparagraph (E), 

23 as inserted by paragraph (1)(C), the following 

24 new subparagraph: 


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1 ‘‘(F) ACCESS REQUIREMENTS.—In order 

2 to assure that enrollees have the option of ob3 taining medication therapy management serv4 ices under this paragraph, a PDP sponsor shall 

5 offer any willing pharmacy in its network and 

6 any other qualified health care provider the op7 portunity to provide such services.’’. 

8 (3) APPROPRIATE REIMBURSEMENT FOR THE

9 PROVISION OF MEDICATION THERAPY MANAGEMENT

10 SERVICES.—Section 1860D–4(c)(2)(J) of such Act 

11 (42 U.S.C. 1395w–104(c)(2)(I)), as redesignated by 

12 paragraph (2), is amended— 

13 (A) in the heading, by striking ‘‘CONSID14 ERATIONS IN PHARMACY FEES’’ and inserting 

15 ‘‘REIMBURSEMENT’’; 

16 (B) by striking the first sentence and in17 serting the following: ‘‘The PDP sponsor shall 

18 reimburse any willing pharmacy in its network 

19 and other qualified health care provider fur20 nishing medication therapy management serv21 ices under this paragraph based on the re22 sources used and the time required to provide 

23 such services.’’; and 


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1 (C) in the second sentence, by striking 

2 ‘‘any such management or dispensing fees’’ and 

3 inserting ‘‘any such reimbursement’’. 

4 (4) EFFECTIVE DATE.—The amendments made 

5 by this subsection shall apply to plan years begin6 ning after the date of enactment of this Act. 

7 (b) INCENTIVES BASED ON PERFORMANCE.— 

8 (1) EVALUATION OF PERFORMANCE FOR PAY9 MENT INCENTIVES.—Section 1860D–4(c)(2) of the 

10 Social Security Act (42 U.S.C. 1395w–104(c)(2)), as 

11 amended by subsection (a), is further amended by 

12 adding at the end the following new subparagraph: 

13 ‘‘(K) EVALUATION OF PERFORMANCE.— 

14 ‘‘(i) DATA COLLECTION AND PER15 FORMANCE MEASURES.— 

16 ‘‘(I) IN GENERAL.—For plan 

17 years beginning after the date of en18 actment of the Medication Therapy 

19 Management Empowerment Act of 

20 2011, the Secretary shall establish 

21 measures and standards for data col22 lection by PDP sponsors to evaluate 

23 the performance of pharmacies and 

24 other entities in furnishing medication 


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1 therapy management services under 

2 this paragraph. 

3 ‘‘(II) MEASURES.—Measures es4 tablished under subclause (I) shall be 

5 designed to help assess and improve 

6 the overall quality of care, including a 

7 reduction in adverse medication reac8 tions, improvements in adherence and 

9 persistence in chronic medication use, 

10 and a reduction in drug spending, 

11 where appropriate. 

12 ‘‘(III) INCLUSION OF CERTAIN

13 MEASURES WITH RESPECT TO PHAR14 MACIST.—In the case of pharmacists 

15 who furnish medication therapy man16 agement services, the measures estab17 lished under subclause (I) shall in18 clude measures developed by the 

19 Pharmacy Quality Alliance. 

20 ‘‘(IV) ENCOURAGING PARTICIPA21 TION OF ENTITIES THAT ACHIEVE

22 BETTER OUTCOMES.—The Secretary 

23 shall compare the outcomes of medica24 tion therapy management services 

25 based on the type of entity offering 


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1 such services and shall develop appro2 priate incentives to ensure broader 

3 participation in the program offered 

4 by the plan sponsor under this para5 graph of entities that achieve better 

6 outcomes (as defined by the Sec7 retary) with respect to such services. 

8 ‘‘(ii) CONTINUAL DEVELOPMENT AND

9 INCORPORATION OF MEDICATION THERAPY

10 MANAGEMENT MEASURES IN BROADER

11 HEALTH CARE OUTCOMES MEASURES.— 

12 The Secretary shall support the continual 

13 development and refinement of perform14 ance measures established under clause 

15 (i)(I), including the incorporation of medi16 cation use measures as part of broader 

17 health care outcomes measures. The Sec18 retary shall work with State plans under 

19 title XIX to incorporate similar perform20 ance-based measures into drug use review 

21 programs under section 1927(g). 

22 ‘‘(iii) INCENTIVE PAYMENTS.—For 

23 plan years beginning on or after January 

24 1, 2012, pharmacies and other entities 

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1 ment services under this paragraph shall 

2 be provided (in a form and manner speci3 fied by the Secretary) additional incentive 

4 payments based on the performance of 

5 such pharmacies and entities in meeting 

6 the performance measures established 

7 under clause (i). Such payments shall be 

8 made from the Medicare Prescription Drug 

9 Account under section 1860D–16, except 

10 that such payments may be made from the 

11 Federal Hospital Insurance Trust Fund 

12 under section 1817 or the Federal Supple13 mentary Medical Insurance Trust Fund 

14 under section 1841 if the Secretary deter15 mines, based on data under this part and 

16 parts A and B, that such services have re17 sulted in a reduction in expenditures under 

18 part A or part B, respectively.’’. 

Æ 


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