MTM Legislation Introduced in the US Senate and House of Representatives

Recently introduced bills seek to expand counseling sessions with pharmacists for patients.

As the Centers for Medicare & Medicaid Services (CMS) administrator, Mark McClellan oversaw the implementation of the Medicare Part D prescription drug program. He understood the importance of pharmacists to the program’s success and how vital medication therapy management (MTM) could be to those efforts. In a 2005 speech regarding the launch of Part D and the law that created it, McClellan made several statements that equally apply to 2013 efforts to expand to MTM:

“To get the most value from the drug benefit, we also want to reward and support the extensive knowledge and real world experience of community pharmacists for assisting in coordinating and managing drug therapies. A key part of achieving this goal is the law’s requirement that every Medicare drug plan have a program to ensure that prescription drugs are used appropriately, to improve outcomes and reduce adverse drug interactions. Pharmacists play a critical role in managing patients’ medication needs, helping patients deal with chronic illnesses, and achieving better health outcomes by improving medication use and reducing the risk of adverse events such as drug interactions. Under the law, plans must implement a program of medication therapy management for certain high-risk beneficiaries, in particular, patients with high spending who take multiple drugs for multiple chronic diseases. Based on the initial results of a variety of medication therapy management programs, we are confident that medication therapy management programs, like other care-coordination programs, will have increasing prominence in Medicare.”

In March of this year, Representative Cathy McMorris Rodgers (R-WA) introduced H.R. 1024, the Medication Therapy Management Empowerment Act of 2013; and soon after Senator Kay Hagan (D-NC) introduced S. 557, the Medication Therapy Management Empowerment Act. The need for this legislation is demonstrated by adherence facts published by NEHI, formerly known as the New England Health Institute. They found America’s health care system wastes up to $290 billion a year on the improper use of medications and approximately 2 billion cases of poor medication adherence are preventable. As a result, NEHI concluded that over $100 billion a year in excess hospitalizations occur. Furthermore, as an indicator of what proper adherence can mean, they found the average health care spending for a low-adherence diabetic patient is $16,499, while a high-adherence patient cost is $8886.

MTM is a great vehicle to reduce costs and improve adherence. The program involves pharmacists working with seniors to review and monitor their medication plan to maximize its effectiveness. Both of the aforementioned bills expand the number of Part D beneficiaries who are eligible for one-on-one counseling sessions with a licensed pharmacist to anyone with a chronic medical condition, such as diabetes or hypertension. This is a departure from the current system that is limited to patients suffering from specific multiple chronic conditions.

The National Community Pharmacists Association (NCPA) is pleased to support beneficiary eligibility pool expanding, common-sense, cost-effective federal legislation that recognizes the growing contributions of pharmacists to patient care. NCPA recently joined others in sending official endorsement letters for H.R. 1024 and S. 557, and certainly encourage Congress to act quickly on both bills.

NCPA’s support for MTM is long-standing. Seven years ago, NCPA created a company called Mirixa to work with independent community pharmacies and health plans in providing MTM services to Medicare beneficiaries and private patients. Those efforts have helped plans and payers lower overall health care costs and enhance the quality of care. The evidence of the effectiveness of MTM can be seen in a Minnesota study, which found a 12:1 return on investment for MTM. In North Carolina, Kerr Drug reports that MTM programs there helping seniors produced a 13:1 return.

The benefits of MTM expansion are readily apparent, and any vehicle in furtherance of that goal should be embraced. So tell your Congressman and your patients to support H.R. 1025 and S. 557.

B. Douglas Hoey is the chief executive officer of the National Community Pharmacists Association. He has spent more than 20 years working in and representing community pharmacies.