On March 18, Sens. Pat Roberts (R-KS), Jeanne Shaheen (D-NH), Sherrod Brown (D-OH), and Mark Kirk (R-IL) introduced the Medication Therapy Management Empowerment Act (S. 776). Sens. Brown and Roberts also sponsored last session’s bill, S. 557, along with Sens. Kay Hagan (D-NC), Al Franken (D-MN), Amy Klobuchar (D-MN), and Tim Johnson (D-SD).
The newly introduced legislation would expand eligibility for medication therapy management (MTM) in Medicare Part D, but is a narrower version of last session’s bill. Currently, in 2015, eligibility for MTM is based on beneficiaries having two to three chronic conditions, taking two to eight Part D covered drugs, and having an annual Part D drug spend of $3,138. The new legislation (S. 776) lowers the chronic disease threshold to one only for four enumerated conditions—cardiovascular disease, chronic obstructive pulmonary disease (COPD), hyperlipidemia, and diabetes. The eligibility criteria related to number of Part D drugs and cost threshold remain unchanged.
Previously, the legislation narrowed the chronic conditions requirement to one, but the list was open-ended and also included mental health conditions, provided that the CMS Chief Actuary did not project increased costs to Medicare associated with the inclusion of a condition. Further, the legislation had a 5-year sunset provision, after which the effects of including a condition (including on patient health as well as Medicare cost/savings) would be evaluated. The eligibility criteria related to number of Part D drugs and cost threshold remained unchanged.
APhA consistently advocates for expansion of, and improvements to, MTM, and supports efforts to affect these changes. APhA will support S. 776 as an important step in the ongoing efforts to secure patient access to robust MTM programs that improve care quality and outcomes. Other pharmacy organizations, including the National Association of Chain Drug Stores and the National Community Pharmacists Association, have also voiced support for S. 776. As the bill is considered, APhA will continue to work with stakeholders to advance MTM through all available channels, including both regulatory and legislative pathways.