I 

111TH CONGRESS 

1ST SESSION H. R. 3108 

To amend part D of title XVIII of the Social Security Act to promote 

medication therapy management under the Medicare part D prescription 

drug program. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2009 

Mr. ROSS introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend part D of title XVIII of the Social Security 

Act to promote medication therapy management under 

the Medicare part D 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 Benefits Act of 2009’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 


smartinez on PROD1PC64 with BILLS
2 

•HR 3108 IH

1 (1) Medications are important to the manage2 ment of chronic diseases that require long-term or 

3 lifelong therapy. Pharmacists are uniquely qualified 

4 as medication experts to work with patients to man5 age their medications and chronic conditions and 

6 play a key role in helping patients take their medica7 tions as prescribed. 

8 (2) Nonadherence with medications is a signifi9 cant problem. According to a report by the World 

10 Health Organization, in developed countries, only 50 

11 percent of patients with chronic diseases adhere to 

12 medication therapies. For example, in the United 

13 States only 51 percent of patients taking blood pres14 sure medications are adherent; similarly, only 40 to 

15 70 percent of patients taking antidepressant medica16 tions adhere to prescribed therapies. 

17 (3) Failure to take medications as prescribed 

18 costs over $177 billion dollars annually. The problem 

19 of nonadherence is particularly important for pa20 tients with chronic diseases that require use of medi21 cations; poor adherence leads to unnecessary disease 

22 progression, reduced functional status, lower quality 

23 of life, and premature death. 

24 (4) When patients adhere to, or comply with, 

25 their medication therapy, it is possible to reduce 


smartinez on PROD1PC64 with BILLS
3 

•HR 3108 IH

1 higher-cost medical attention, such as emergency de2 partment visits and catastrophic care, and avoid the 

3 preventable human costs that impact patients and 

4 those who care for them. 

5 (5) Studies have clearly demonstrated that com6 munity-based medication therapy management 

7 (MTM) services provided by pharmacists improve 

8 health care outcomes and reduce spending. For ex9 ample, the Asheville Project—a diabetes program 

10 designed for city employees in Asheville, North Caro11 lina, and delivered by community pharmacists—re12 sulted over a 5-year period in a decrease in total di13 rect medical costs ranging from $1,622 to $3,356 

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

15 use of sick days, and an increase in productivity ac16 counting for an estimated savings of $18,000 annu17 ally. Another project involving pharmacist-provided 

18 care to patients with high cholesterol increased com19 pliance with medication to 90 percent from a na20 tional average of 40 percent. In North Carolina, the 

21 ChecKmeds NC program, which offers eligible sen22 iors one-on-one MTM consultations with phar23 macists, saved an estimated $10,000,000 in 

24 healthcare costs and avoided numerous health prob25 lems in the first year of the program for the more 


smartinez on PROD1PC64 with BILLS
4 

•HR 3108 IH

1 than 15,000 seniors receiving MTM. Similar results 

2 have been achieved in several other demonstrations 

3 using community pharmacists. 

4 (6) Therefore, enhancement of the MTM ben5 efit under part D of the Medicare program should 

6 be a key component of the national health care re7 form agenda. 

8 SEC. 3. IMPROVEMENT IN PART D MEDICATION THERAPY 

9 MANAGEMENT (MTM) PROGRAMS. 

10 (a) IN GENERAL.—Section 1860D–4(c)(2) of the So11 cial Security Act (42 U.S.C. 1395w–104(c)(2)) is amend12 ed— 

13 (1) by redesignating subparagraphs (C) through 

14 (E) as subparagraphs (F) through (H), respectively; 

15 and 

16 (2) by inserting after subparagraph (B) the fol17 lowing new subparagraph: 

18 ‘‘(C) REQUIRED REVIEWS AND INTERVEN19 TIONS.—Beginning in the first plan year after 

20 the date of the enactment of the Medication 

21 Therapy Management Benefits Act of 2009, 

22 PDP sponsors shall offer medication therapy 

23 management services to targeted beneficiaries 

24 described in subparagraph (A)(ii) that include, 


smartinez on PROD1PC64 with BILLS
5 

•HR 3108 IH

1 at a minimum, the following to increase adher2 ence to prescription medications: 

3 ‘‘(i) An annual comprehensive medica4 tion review furnished person-to-person by a 

5 licensed pharmacist. The comprehensive 

6 medication review— 

7 ‘‘(I) shall include a review of the 

8 individual’s medications, creation of a 

9 personal medication record, and a rec10 ommended medication action plan in 

11 consultation with the individual and 

12 the prescriber; and 

13 ‘‘(II) shall include providing the 

14 patient with a written or printed sum15 mary. 

16 ‘‘(ii) Targeted medication reviews fur17 nished person-to-person by a licensed phar18 macist offered no less frequently than once 

19 every quarter to assess medication use 

20 since the last annual comprehensive medi21 cation review, to monitor unresolved issues, 

22 to identify problems with new drug thera23 pies or if the individual has experienced a 

24 transition in care. 


smartinez on PROD1PC64 with BILLS
6 

•HR 3108 IH

1 ‘‘(iii) Followup interventions, which 

2 may be provided person-to-person or 

3 through other interactive means, on a 

4 schedule and frequency recommended by 

5 the prescriber or a licensed pharmacist.’’. 

6 (b) INCREASE AVAILABILITY OF MTM SERVICES TO

7 BENEFICIARIES AND INCREASE COMMUNITY PHARMACY

8 INVOLVEMENT IN PROVISION OF MTM SERVICES.— 

9 (1) INCREASED BENEFICIARY ACCESS TO MTM

10 SERVICES.—Section 1860D–4(c)(2) of such Act (42 

11 U.S.C. 1395w–104(c)(2)), as amended by subsection 

12 (a), is further amended— 

13 (A) in subparagraph (A)(ii)(I), by inserting 

14 before the semicolon at the end the following: 

15 ‘‘or any chronic disease that accounts for high 

16 spending in the Medicare program including di17 abetes, hypertension, heart failure, 

18 dyslipidemia, respiratory disease (such as asth19 ma, chronic obstructive pulmonary disease or 

20 chronic lung disorders), bone disease-arthritis 

21 (such as osteoporosis and osteoarthritis), rheu22 matoid arthritis, and mental health (such as de23 pression, schizophrenia, or bipolar disorder)’’; 

24 (B) by adding at the end of subparagraph 

25 (A) the following new clause: 


smartinez on PROD1PC64 with BILLS
7 

•HR 3108 IH

1 ‘‘(iii) IDENTIFICATION OF INDIVID2 UALS WHO MAY BENEFIT FROM MEDICA3 TION THERAPY MANAGEMENT.—The PDP 

4 sponsor shall identify a process subject to 

5 the Secretary’s approval that allows phar6 macists or other qualified providers to 

7 identify enrollees for medication therapy 

8 management interventions where such indi9 viduals are not described as targeted bene10 ficiaries under clause (ii) or are not other11 wise offered services described in para12 graph (C).’’; and 

13 (C) by inserting after subparagraph (C) 

14 the following new subparagraph: 

15 ‘‘(D) MEDICATION REVIEWS FOR DUAL

16 ELIGIBLES AND ENROLLEES IN TRANSITION OF

17 CARE.—Without regard to whether an enrollee 

18 is a targeted beneficiary described in subpara19 graph (A)(ii), the medication therapy manage20 ment program under this program shall offer— 

21 ‘‘(i) a comprehensive medication re22 view described in subparagraph (C)(i) at 

23 the time of initial enrollment under the 

24 plan for an enrollee who is a full-benefit 


smartinez on PROD1PC64 with BILLS
8 

•HR 3108 IH

1 dual eligible individual (as defined in sec2 tion 1935(c)(6)); and 

3 ‘‘(ii) a targeted medication review de4 scribed in subparagraph (C)(ii) for any en5 rollee at the time of transition of care 

6 (such as being discharged from a hospital 

7 or another institutional setting) where new 

8 medications have been introduced to the 

9 individual’s therapy.’’. 

10 (c) COMMUNITY PHARMACY ACCESS.—Section 

11 1840D–4(c)(2) of such Act is further amended by insert12 ing after subparagraph (D) the following new subpara13 graph: 

14 ‘‘(E) PHARMACY ACCESS REQUIRE15 MENTS.—A PDP sponsor shall offer any willing 

16 pharmacy in its network the ability to provide 

17 medication therapy management services to as18 sure that enrollees have the option of obtaining 

19 services under the medication therapy manage20 ment program from community-based retail 

21 pharmacies.’’. 

22 (d) REIMBURSEMENT AND INCENTIVES BASED ON

23 PERFORMANCE.— 

24 (1) APPROPRIATE REIMBURSEMENT FOR THE

25 PROVISION OF MTM SERVICES.—Section 1860D– 


smartinez on PROD1PC64 with BILLS
9 

•HR 3108 IH

1 4(c)(2)(H) of such Act, as redesignated by sub2 section (a), is amended by striking the first sentence 

3 and inserting the following: ‘‘The PDP sponsor shall 

4 reimburse pharmacists and other entities furnishing 

5 medication therapy management services under this 

6 paragraph based on the resources used and the time 

7 required to provide such services.’’. 

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

10 Act (42 U.S.C. 1395w–104(c)(2)) is amended by 

11 adding at the end the following new subparagraph: 

12 ‘‘(I) EVALUATION OF PERFORMANCE.— 

13 ‘‘(i) DATA COLLECTION AND PRO14 VIDER MEASURES.—Effective beginning in 

15 the first plan year after the date of the en16 actment of the Medication Therapy Man17 agement Benefits Act of 2009, the Sec18 retary shall establish measures and stand19 ards for data collection by PDP sponsors 

20 to evaluate performance of pharmacies and 

21 other entities in furnishing medication 

22 therapy management services. Such meas23 ures shall be designed to help assess and 

24 improve overall quality of care, including a 

25 reduction in adverse medication reactions, 


smartinez on PROD1PC64 with BILLS
10 

•HR 3108 IH

1 improvements in adherence and persistence 

2 in chronic medication use, and a reduction 

3 in drug spending, where appropriate. PDP 

4 sponsors shall also compare outcomes 

5 based on the type of entity offering such 

6 services and shall ensure broader participa7 tion of entities that achieve better out8 comes with respect to such services. The 

9 measures established under this clause 

10 shall include measures developed by the 

11 Pharmacy Quality Alliance (PQA) in the 

12 case of pharmacist providers. 

13 ‘‘(ii) CONTINUAL DEVELOPMENT AND

14 INCORPORATION OF MEDICATION THERAPY

15 MANAGEMENT MEASURES IN BROADER

16 HEALTH CARE OUTCOMES MEASURES.— 

17 The Secretary shall support the continual 

18 development and refinement of perform19 ance measures described in clause (i), in20 cluding the incorporation of medication use 

21 measures as part of broader health care 

22 outcomes measures. The Secretary shall 

23 work with state Medicaid programs to in24 corporate similar performance-based measVerDate Nov 24 2008 02:18 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3108.IH H3108

smartinez on PROD1PC64 with BILLS
11 

•HR 3108 IH

1 ures into State-required Drug Use Review 

2 programs under title XIX. 

3 ‘‘(iii) INCENTIVE PAYMENTS.—Begin4 ning with plan year 2011, pharmacies and 

5 other entities that furnish medication ther6 apy management services under this part 

7 shall be provided (in a manner specified by 

8 the Secretary) with additional incentive 

9 payments based on the performance of 

10 such pharmacies and entities in meeting 

11 the quality measures established under 

12 clause (i). Such payments shall be made 

13 from the Medicare Prescription Drug Ac14 count except that such payments may be 

15 made from the Federal Hospital Insurance 

16 Trust Fund or the Federal Supplemental 

17 Medical Insurance Trust Fund if the Sec18 retary determines, based on data under 

19 this part and parts A and B, that such 

20 services have resulted in a reduction in ex21 penditures under part A or part B, respec22 tively.’’. 

Æ 


smartinez on PROD1PC64 with BILLS