II 

111TH CONGRESS 

2D SESSION S. 3543 

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 

JUNE 29, 2010 

Mrs. HAGAN (for herself and Mr. FRANKEN) 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 Expanded Benefits Act of 2010’’. 

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, saved an estimated $10,000,000 in 

24 healthcare costs and avoided numerous health probVerDate Mar 15 2010 04:17 Jun 30, 2010 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3543.IS S3543

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1 lems in the first year of the program for the more 

2 than 15,000 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 (10) In recognition of the benefits of medication 

7 therapy management, enhancement of the medica8 tion therapy management benefit the Medicare pre9 scription drug program under part D of title XVIII 

10 of the Social Security Act was an important compo11 nent of the national health care reform agenda dur12 ing 2009 and 2010. 

13 SEC. 3. IMPROVEMENT IN PART D MEDICATION THERAPY 

14 MANAGEMENT PROGRAMS. 

15 (a) INCREASED AVAILABILITY AND COMMUNITY

16 PHARMACY INVOLVEMENT IN THE PROVISION OF MEDI17 CATION THERAPY MANAGEMENT SERVICES.— 

18 (1) INCREASED BENEFICIARY ACCESS TO MEDI19 CATION THERAPY MANAGEMENT SERVICES.—Section 

20 1860D–4(c)(2) of the Social Security Act (42 U.S.C. 

21 1395w–104(c)(2)), as amended by section 10328 of 

22 the Patient Protection and Affordable Care Act 

23 (Public Law 111–148), is amended— 

24 (A) in subparagraph (A)— 


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

2 any chronic disease that accounts for high 

3 spending in the program under this title, 

4 including diabetes, hypertension, heart fail5 ure, dyslipidemia, respiratory disease (such 

6 as asthma, chronic obstructive pulmonary 

7 disease or chronic lung disorders), bone 

8 disease-arthritis (such as osteoporosis and 

9 osteoarthritis), rheumatoid arthritis, and 

10 mental health (such as depression, schizo11 phrenia, or bipolar disorder)’’ before the 

12 semicolon at the end; and 

13 (ii) by adding at the end the following 

14 new clause: 

15 ‘‘(iii) IDENTIFICATION OF INDIVID16 UALS WHO MAY BENEFIT FROM MEDICA17 TION THERAPY MANAGEMENT.—The PDP 

18 sponsor shall, subject to the approval of 

19 the Secretary, establish a process for iden20 tifying individuals who— 

21 ‘‘(I) are not targeted bene22 ficiaries described in clause (ii); 

23 ‘‘(II) are not otherwise offered 

24 medication therapy management serv25 ices; and 


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1 ‘‘(III) a pharmacist or other 

2 qualified provider determines may 

3 benefit from medication therapy man4 agement services. 

5 For purposes of this paragraph, any indi6 vidual identified under this clause shall be 

7 treated as a targeted beneficiary described 

8 in clause (ii).’’; 

9 (B) by redesignating— 

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

11 as redesignated by paragraph (1) of such 

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

13 and (I), respectively; and 

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

15 paragraph (2) of such section 10328, as 

16 subparagraph (F); and 

17 (C) by inserting after subparagraph (D) 

18 the following new subparagraph: 

19 ‘‘(E) MEDICATION REVIEWS FOR DUAL

20 ELIGIBLES AND ENROLLEES IN TRANSITION OF

21 CARE.—Without regard to whether an enrollee 

22 is a targeted beneficiary described in subpara23 graph (A)(ii), the medication therapy manage24 ment program under this paragraph shall offer 

25 the following: 


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

2 a full-benefit dual eligible individual (as 

3 defined in section 1935(c)(6)), a com4 prehensive medication review described in 

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

6 preceding sentence shall be offered at the 

7 time of the initial enrollment of such indi8 vidual in the prescription drug plan. 

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

10 is experiencing a transition in care (such 

11 as being discharged from a hospital or 

12 other institutional setting), a targeted 

13 medication review described in subpara14 graph (C)(ii) of any new medications that 

15 have been introduced to the enrollee’s ther16 apy. The review under the preceding sen17 tence shall be offered at the time of such 

18 transition.’’. 

19 (2) ACCESS TO MEDICATION MANAGEMENT

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

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

22 (A) by redesignating— 

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

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


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1 subparagraphs (H), (I), and (J), respec2 tively; and 

3 (ii) subparagraph (F), as redesignated 

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

5 (G); and 

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

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

8 new subparagraph: 

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

10 to assure that enrollees have the option of ob11 taining medication therapy management serv12 ices under this paragraph, a PDP sponsor shall 

13 offer any willing pharmacy in its network and 

14 any other qualified health care provider the op15 portunity to provide such services.’’. 

16 (3) APPROPRIATE REIMBURSEMENT FOR THE

17 PROVISION OF MEDICATION THERAPY MANAGEMENT

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

19 (42 U.S.C. 1395w–104(c)(2)(I)), as redesignated by 

20 paragraph (2), is amended— 

21 (A) in the heading, by striking ‘‘CONSID22 ERATIONS IN PHARMACY FEES’’ and inserting 

23 ‘‘REIMBURSEMENT’’; 

24 (B) by striking the first sentence and in25 serting the following: ‘‘The PDP sponsor shall 


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1 reimburse any willing pharmacy in its network 

2 and other qualified health care provider fur3 nishing medication therapy management serv4 ices under this paragraph based on the re5 sources used and the time required to provide 

6 such services.’’; and 

7 (C) in the second sentence, by striking 

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

9 inserting ‘‘any such reimbursement’’. 

10 (4) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall apply to plan years begin12 ning after the date of enactment of this Act. 

13 (b) INCENTIVES BASED ON PERFORMANCE.— 

14 (1) EVALUATION OF PERFORMANCE FOR PAY15 MENT INCENTIVES.—Section 1860D–4(c)(2) of the 

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

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

18 adding at the end the following new subparagraph: 

19 ‘‘(I) EVALUATION OF PERFORMANCE.— 

20 ‘‘(i) DATA COLLECTION AND PER21 FORMANCE MEASURES.— 

22 ‘‘(I) IN GENERAL.—For plan 

23 years beginning after the date of en24 actment of the Medication Therapy 

25 Management Expanded Benefits Act 


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1 of 2010, the Secretary shall establish 

2 measures and standards for data col3 lection by PDP sponsors to evaluate 

4 the performance of pharmacies and 

5 other entities in furnishing medication 

6 therapy management services under 

7 this paragraph. 

8 ‘‘(II) MEASURES.—Measures es9 tablished under subclause (I) shall be 

10 designed to help assess and improve 

11 the overall quality of care, including a 

12 reduction in adverse medication reac13 tions, improvements in adherence and 

14 persistence in chronic medication use, 

15 and a reduction in drug spending, 

16 where appropriate. 

17 ‘‘(III) INCLUSION OF CERTAIN

18 MEASURES WITH RESPECT TO PHAR19 MACIST.—In the case of pharmacists 

20 who furnish medication therapy man21 agement services, the measures estab22 lished under subclause (I) shall in23 clude measures developed by the 

24 Pharmacy Quality Alliance. 


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1 ‘‘(IV) ENCOURAGING PARTICIPA2 TION OF ENTITIES THAT ACHIEVE

3 BETTER OUTCOMES.—The Secretary 

4 shall compare the outcomes of medica5 tion therapy management services 

6 based on the type of entity offering 

7 such services and shall develop appro8 priate incentives to ensure broader 

9 participation in the program offered 

10 by the plan sponsor under this para11 graph of entities that achieve better 

12 outcomes (as defined by the Sec13 retary) with respect to such services. 

14 ‘‘(ii) CONTINUAL DEVELOPMENT AND

15 INCORPORATION OF MEDICATION THERAPY

16 MANAGEMENT MEASURES IN BROADER

17 HEALTH CARE OUTCOMES MEASURES.— 

18 The Secretary shall support the continual 

19 development and refinement of perform20 ance measures established under clause 

21 (i)(I), including the incorporation of medi22 cation use measures as part of broader 

23 health care outcomes measures. The Sec24 retary shall work with State plans under 

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1 ance-based measures into drug use review 

2 programs under section 1927(g). 

3 ‘‘(iii) INCENTIVE PAYMENTS.—For 

4 plan years beginning on or after January 

5 1, 2011, pharmacies and other entities 

6 that furnish medication therapy manage7 ment services under this paragraph shall 

8 be provided (in a form and manner speci9 fied by the Secretary) additional incentive 

10 payments based on the performance of 

11 such pharmacies and entities in meeting 

12 the performance measures established 

13 under clause (i). Such payments shall be 

14 made from the Medicare Prescription Drug 

15 Account under section 1860D–16, except 

16 that such payments may be made from the 

17 Federal Hospital Insurance Trust Fund 

18 under section 1817 or the Federal Supple19 mentary Medical Insurance Trust Fund 

20 under section 1841 if the Secretary deter21 mines, based on data under this part and 

22 parts A and B, that such services have re23 sulted in a reduction in expenditures under 

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

Æ 


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