MTM legislation reintroduced in Congress

Abstract

Two new bills introduced in Congress would allow individuals with a single chronic disease to qualify for medication therapy management (MTM) services under Part D of the Medicare program. The Medication Therapy Management Empowerment Act of 2013 (H.R. 1024), introduced by Rep. Cathy McMorris Rodgers (R-WA) on March 7, and its companion bill of the same name (S. 557), introduced by Sen. Kay Hagan (D-NC) on March 13, would allow the act to be applied for a particular single chronic disease only if overall costs to Medicare would not increase over the following 5-year period.■The Medication Therapy Management Empowerment Act of 2013 was introduced in the House (H.R. 1024) and in the Senate (S. 557) last month.■The new bills would allow patients with a single chronic disease to qualify for Part D MTM. ■The Medication Therapy Management Empowerment Act of 2013 was introduced in the House (H.R. 1024) and in the Senate (S. 557) last month.■The new bills would allow patients with a single chronic disease to qualify for Part D MTM. “Once again, Rep. McMorris Rodgers and Sen. Hagan have shown their support of pharmacists by reintroducing MTM legislation,” said Michael Spira, APhA Senior Lobbyist. “We have long advocated that pharmacists’ services such as MTM will help improve patient outcomes and reduce overall health care costs, especially among those who have chronic diseases like diabetes.” Currently, the Medicare Part D MTM program applies only to targeted beneficiaries who have multiple chronic diseases such as diabetes, asthma, hypertension, hyperlipidemia, and congestive heart failure; take multiple Part D medications; and meet an established cost threshold. The reintroduced legislation includes any single chronic disease such as the above or heart failure, dyslipidemia, other respiratory diseases (chronic obstructive pulmonary disease or chronic lung disorder), bone disease arthritis and rheumatoid arthritis, or a mental health disorder such as depression, schizophrenia, or bipolar disorder. Two bills introduced in the last session of Congress would have increased the number of conditions that would qualify individuals for MTM services. In addition, pharmacists would have been able to identify individuals who could benefit from MTM but do not qualify under their Part D plan. Dual-eligible individuals would have received MTM services even if they weren’t targeted beneficiaries. The introduction of the new MTM bills in both the House and Senate demonstrates continued congressional interest in improving MTM services. In the current Part D program, individuals qualify for MTM services by meeting specific criteria established by prescription drug plans (PDPs) based on the targeting parameters described previously. The bills also would have required that PDPs offer any willing pharmacy or health care provider the opportunity to provide MTM services. The introduction of the new MTM bills in both the House and Senate demonstrates continued congressional interest in improving MTM services. Pharmacists’ continued support and advocacy, including lobbying elected officials about the importance of MTM, will be key to passage of the new legislation. Other pharmacy groups have applauded the new bills, including the National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores (NACDS). “With improper use of medications costing an estimated $290 billion a year, medication therapy management programs can reduce serious health risks among patients and save money,” said NCPA CEO B. Douglas Hoey, BSPharm, MBA, in a March 7 NCPA news release on the House bill. “NCPA is once again pleased to support federal legislation to expand the number of seniors eligible for this service,” Hoey added in a March 14 NCPA news release on the Senate bill. NACDS also issued a March 7 news release endorsing the House bill and a March 15 news release applauding the Senate bill. “Pharmacists are widely trusted health care professionals with extensive education. They are trained medication specialists who work collaboratively to help patients use medicines safely and stay healthy,” said NACDS President and CEO Steven C. Anderson, IOM, CAE, in the March 7 news release.