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 juris-
diction 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medication Therapy 
Management Benefits Act of 2009’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Medications are important to the manage-
ment of chronic diseases that require long-term or 
lifelong therapy. Pharmacists are uniquely qualified 
as medication experts to work with patients to man-
age their medications and chronic conditions and 
play a key role in helping patients take their medica-
tions as prescribed. 
(2) Nonadherence with medications is a signifi-
cant problem. According to a report by the World 
Health Organization, in developed countries, only 50 
percent of patients with chronic diseases adhere to 
medication therapies. For example, in the United 
States only 51 percent of patients taking blood pres-
sure medications are adherent; similarly, only 40 to 
70 percent of patients taking antidepressant medica-
tions adhere to prescribed therapies. 
(3) Failure to take medications as prescribed 
costs over $177 billion dollars annually. The problem 
of nonadherence is particularly important for pa-
tients with chronic diseases that require use of medi-
cations; poor adherence leads to unnecessary disease 
progression, reduced functional status, lower quality 
of life, and premature death. 
(4) When patients adhere to, or comply with, 
their medication therapy, it is possible to reduce 
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higher-cost medical attention, such as emergency de-
partment visits and catastrophic care, and avoid the 
preventable human costs that impact patients and 
those who care for them. 
(5) Studies have clearly demonstrated that com-
munity-based 
medication 
therapy 
management 
(MTM) services provided by pharmacists improve 
health care outcomes and reduce spending. For ex-
ample, the Asheville Project—a diabetes program 
designed for city employees in Asheville, North Caro-
lina, and delivered by community pharmacists—re-
sulted over a 5-year period in a decrease in total di-
rect medical costs ranging from $1,622 to $3,356 
per patient per year, a 50 percent decrease in the 
use of sick days, and an increase in productivity ac-
counting for an estimated savings of $18,000 annu-
ally. Another project involving pharmacist-provided 
care to patients with high cholesterol increased com-
pliance with medication to 90 percent from a na-
tional average of 40 percent. In North Carolina, the 
ChecKmeds NC program, which offers eligible sen-
iors one-on-one MTM consultations with phar-
macists, 
saved 
an 
estimated 
$10,000,000 
in 
healthcare costs and avoided numerous health prob-
lems in the first year of the program for the more 
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than 15,000 seniors receiving MTM. Similar results 
have been achieved in several other demonstrations 
using community pharmacists. 
(6) Therefore, enhancement of the MTM ben-
efit under part D of the Medicare program should 
be a key component of the national health care re-
form agenda. 
SEC. 3. IMPROVEMENT IN PART D MEDICATION THERAPY 
MANAGEMENT (MTM) PROGRAMS. 
(a) IN GENERAL.—Section 1860D–4(c)(2) of the So-
cial Security Act (42 U.S.C. 1395w–104(c)(2)) is amend-
ed— 
(1) by redesignating subparagraphs (C) through 
(E) as subparagraphs (F) through (H), respectively; 
and 
(2) by inserting after subparagraph (B) the fol-
lowing new subparagraph: 
‘‘(C) REQUIRED REVIEWS AND INTERVEN-
TIONS.—Beginning in the first plan year after 
the date of the enactment of the Medication 
Therapy Management Benefits Act of 2009, 
PDP sponsors shall offer medication therapy 
management services to targeted beneficiaries 
described in subparagraph (A)(ii) that include, 
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‘‘(iii) Followup interventions, which 
may 
be 
provided 
person-to-person 
or 
through other interactive means, on a 
schedule and frequency recommended by 
the prescriber or a licensed pharmacist.’’. 
(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)), as amended by subsection 
(a), 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: 
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‘‘(iii) IDENTIFICATION
OF
INDIVID-
UALS WHO MAY BENEFIT FROM MEDICA-
TION THERAPY MANAGEMENT.—The PDP 
sponsor shall identify a process subject to 
the Secretary’s approval that allows phar-
macists or other qualified providers to 
identify enrollees for medication therapy 
management interventions where such indi-
viduals are not described as targeted bene-
ficiaries under clause (ii) or are not other-
wise offered services described in para-
graph (C).’’; and 
(C) by inserting after subparagraph (C) 
the following new subparagraph: 
‘‘(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 
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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.’’. 
(c) 
COMMUNITY
PHARMACY
ACCESS.—Section 
1840D–4(c)(2) of such Act is further amended by insert-
ing after subparagraph (D) the following new subpara-
graph: 
‘‘(E) 
PHARMACY
ACCESS
REQUIRE-
MENTS.—A PDP sponsor shall offer any willing 
pharmacy in its network the ability to provide 
medication therapy management services to as-
sure that enrollees have the option of obtaining 
services under the medication therapy manage-
ment program from community-based retail 
pharmacies.’’. 
(d) REIMBURSEMENT AND INCENTIVES BASED ON 
PERFORMANCE.— 
(1) APPROPRIATE REIMBURSEMENT FOR THE 
PROVISION
OF
MTM
SERVICES.—Section 1860D– 
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4(c)(2)(H) of such Act, as redesignated by sub-
section (a), 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)) is amended by 
adding at the end the following new subparagraph: 
‘‘(I) EVALUATION OF PERFORMANCE.— 
‘‘(i) DATA
COLLECTION
AND
PRO-
VIDER MEASURES.—Effective beginning in 
the first plan year after the date of the en-
actment of the Medication Therapy Man-
agement Benefits Act of 2009, the Sec-
retary shall establish measures and stand-
ards for data collection by PDP sponsors 
to evaluate performance of pharmacies and 
other entities in furnishing medication 
therapy management services. Such meas-
ures shall be designed to help assess and 
improve overall quality of care, including a 
reduction in adverse medication reactions, 
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improvements in adherence and persistence 
in chronic medication use, and a reduction 
in drug spending, where appropriate. PDP 
sponsors shall also compare outcomes 
based on the type of entity offering such 
services and shall ensure broader participa-
tion of entities that achieve better out-
comes with respect to such services. The 
measures established under this clause 
shall include measures developed by the 
Pharmacy Quality Alliance (PQA) in the 
case of pharmacist providers. 
‘‘(ii) CONTINUAL DEVELOPMENT AND 
INCORPORATION OF MEDICATION THERAPY 
MANAGEMENT
MEASURES
IN
BROADER 
HEALTH
CARE
OUTCOMES
MEASURES.— 
The Secretary shall support the continual 
development and refinement of perform-
ance measures described in clause (i), in-
cluding the incorporation of medication use 
measures as part of broader health care 
outcomes measures. The Secretary shall 
work with state Medicaid programs to in-
corporate similar performance-based meas-
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ures into State-required Drug Use Review 
programs under title XIX. 
‘‘(iii) INCENTIVE PAYMENTS.—Begin-
ning with plan year 2011, pharmacies and 
other entities that furnish medication ther-
apy management services under this part 
shall be provided (in a manner specified by 
the Secretary) with additional incentive 
payments based on the performance of 
such pharmacies and entities in meeting 
the quality measures established under 
clause (i). Such payments shall be made 
from the Medicare Prescription Drug Ac-
count except that such payments may be 
made from the Federal Hospital Insurance 
Trust Fund or the Federal Supplemental 
Medical Insurance Trust Fund if the Sec-
retary determines, based on data under 
this part and parts A and B, that such 
services have resulted in a reduction in ex-
penditures under part A or part B, respec-
tively.’’. 
Æ 
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