every quarter to assess medication use 
since the last annual comprehensive medi-
cation review, to monitor unresolved issues, 
to identify problems with new drug thera-
pies or if the individual has experienced a 
transition in care.’’. 
(b) INCREASE AVAILABILITY OF MTM SERVICES TO 
BENEFICIARIES AND INCREASE COMMUNITY PHARMACY 
INVOLVEMENT IN PROVISION OF MTM SERVICES.— 
(1) INCREASED BENEFICIARY ACCESS TO MTM 
SERVICES.—Section 1860D–4(c)(2) of such Act (42 
U.S.C. 1395w–104(c)(2)) is further amended— 
(A) in subparagraph (A)(ii)(I), by inserting 
before the semicolon at the end the following: 
‘‘or any chronic disease that accounts for high 
spending in the Medicare program including di-
abetes, 
hypertension, 
heart 
failure, 
dyslipidemia, respiratory disease (such as asth-
ma, chronic obstructive pulmonary disease or 
chronic lung disorders), bone disease-arthritis 
(such as osteoporosis and osteoarthritis), rheu-
matoid arthritis, and mental health (such as de-
pression, schizophrenia, or bipolar disorder)’’; 
(B) by adding at the end of subparagraph 
(A) the following new clause: 
VerDate Mar 15 2010 
00:41 Mar 05, 2011
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H891.IH
H891
rfrederick on DSKD9S0YB1PROD with BILLS
‘‘(iii) IDENTIFICATION
OF
INDIVID-
UALS WHO MAY BENEFIT FROM MEDICA-
TION
THERAPY
MANAGEMENT.—The pre-
scription drug plan sponsor shall identify a 
process subject to the Secretary’s approval 
that allows licensed pharmacists or other 
qualified providers to identify for medica-
tion therapy management interventions po-
tential enrollees who are not described as 
targeted beneficiaries under clause (ii) or 
are not otherwise offered services described 
in subparagraph (C).’’; 
(C) by redesignating subparagraphs (F) 
and (G) as subparagraphs (I) and (J), respec-
tively; 
(D) by redesignating the subparagraph 
(E), relating to development of program in co-
operation with licensed pharmacists, as sub-
paragraph (H); 
(E) by redesignating subparagraph (D) 
and the subparagraph (E), relating to auto-
matic enrollment with ability to opt-out, as sub-
paragraphs (F) through (G), respectively; and 
(F) by inserting after subparagraph (C) 
the following new subparagraph: 
VerDate Mar 15 2010 
00:41 Mar 05, 2011
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H891.IH
H891
rfrederick on DSKD9S0YB1PROD with BILLS
‘‘(D) MEDICATION
REVIEWS
FOR
DUAL 
ELIGIBLES AND ENROLLEES IN TRANSITION OF 
CARE.—Without regard to whether an enrollee 
is a targeted beneficiary described in subpara-
graph (A)(ii), the medication therapy manage-
ment program under this program shall offer— 
‘‘(i) a comprehensive medication re-
view described in subparagraph (C)(i) at 
the time of initial enrollment under the 
plan for an enrollee who is a full-benefit 
dual eligible individual (as defined in sec-
tion 1935(c)(6)); and 
‘‘(ii) a targeted medication review de-
scribed in subparagraph (C)(ii) for any en-
rollee at the time of transition of care 
(such as being discharged from a hospital 
or another institutional setting) where new 
medications have been introduced to the 
individual’s therapy.’’. 
(2) COMMUNITY
PHARMACY
ACCESS.—Section 
1840D–4(c)(2) of such Act, as amended by para-
graph (1), is further amended by inserting after sub-
paragraph (D) the following new subparagraph: 
‘‘(E) 
PHARMACY
ACCESS
REQUIRE-
MENTS.—A prescription drug plan sponsor shall 
VerDate Mar 15 2010 
00:41 Mar 05, 2011
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H891.IH
H891
rfrederick on DSKD9S0YB1PROD with BILLS
offer any willing pharmacy in its network the 
ability to provide medication therapy manage-
ment services to assure that enrollees have the 
option of obtaining services under the medica-
tion therapy management program from com-
munity-based retail pharmacies.’’. 
(c) REIMBURSEMENT AND INCENTIVES BASED ON 
PERFORMANCE.— 
(1) APPROPRIATE REIMBURSEMENT FOR THE 
PROVISION
OF
MTM
SERVICES.—Section 1860D– 
4(c)(2)(J) 
of 
such 
Act 
(42 
U.S.C. 
1395w– 
104(c)(2)(J)), 
as 
redesignated 
by 
subsection 
(b)(1)(C), is amended by striking the first sentence 
and inserting the following: ‘‘The PDP sponsor shall 
reimburse pharmacists and other entities furnishing 
medication therapy management services under this 
paragraph based on the resources used and the time 
required to provide such services.’’. 
(2) EVALUATION OF PERFORMANCE FOR PAY-
MENT INCENTIVES.—Section 1860D–4(c)(2) of such 
Act (42 U.S.C. 1395w–104(c)(2)), as amended by 
subsection (b), is further amended by adding at the 
end the following new subparagraph: 
‘‘(K) EVALUATION OF PERFORMANCE.— 
VerDate Mar 15 2010 
00:41 Mar 05, 2011
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H891.IH
H891
rfrederick on DSKD9S0YB1PROD with BILLS
‘‘(i) DATA
COLLECTION
AND
PRO-
VIDER
MEASURES.—The Secretary shall 
establish measures and standards for data 
collection by prescription drug plan spon-
sors to evaluate performance of pharmacies 
and other entities in furnishing medication 
therapy management services. Such meas-
ures and standards shall be developed by 
such date as to allow the application of 
such measures under this subparagraph 
beginning with the first plan year begin-
ning after the date of the enactment of the 
Medication Therapy Management Benefits 
Act of 2011. Such measures shall be de-
signed to help assess and improve overall 
quality of care, including a reduction in 
adverse medication reactions, improve-
ments in adherence and persistence in 
chronic medication use, and a reduction in 
drug spending, where appropriate. Pre-
scription drug plan sponsors shall use such 
measures to compare outcomes based on 
the type of entity offering such services 
and shall ensure broader participation of 
entities that achieve better outcomes with 
VerDate Mar 15 2010 
00:41 Mar 05, 2011
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H891.IH
H891
rfrederick on DSKD9S0YB1PROD with BILLS