,,ii #aadth ,,congress #b;d ,session ,s4 #cded ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #bh1 #bjaf ,mr4 ,carper 7for himself and ,mr4 ,roberts7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to improve medication adherence4 #a4 ,findings ,congress makes the following findings3 7#a7 ,eighty to ninety percent of the means by which we prevent and control chronic disease is with medications4 ,assuring the most appropriate and effective medications are used to optimize patient outcomes is a national priority4 ,the ability of patients to then adhere to the medication regimen becomes vital4 7#b7 ,between #a_/b and #b_/c of individuals with chronic diseases in the ,united ,states do not take medications as prescribed4 7#c7 ,suboptimal medication use1 including untreated indications 7such as failure to immunize71 over or under dosing of medications1 safety issues1 and low rates of medication adherence result in higher health care costs1 reduced effectiveness of health care treatments and regimes1 negative health effects for patients1 and tens of thousands of deaths on an annual basis4 7#d7 ,appropriate medication use and adherence may be lowest among individuals with chronic diseases4 7#e7 ,improving medication adherence would reduce unnecessary hospital admissions and emergency room visits4 7#f7 ,drug therapy problems including underuse and nonadherence is estimated to cost the healthcare system in the ,united ,states over #bij1jjj1jjj1jjj each year4 7#g7 ,improving appropriate medication adherence could improve patient health outcomes1 reduce health care costs1 and lead to productivity gains4 #b4 ,national research and reporting strategy for improved medication adherence ,part ,a of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cda et seq47 is amended by adding at the end the following3 #caj;,b4 ,national research and reporting strategy for improved medication adherence 7a7 ,in general ,the ,secretary1 in coordination with the ,administrator of the ,agency for ,healthcare ,research and ,quality1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,director of the ,centers for ,disease ,control and ,prevention1 shall report annual statistics on medication adherence1 particularly with respect to individuals with chronic diseases such as cardiovascular disease1 hypertension1 diabetes1 autoimmune diseases1 chronic obstructive pulmonary disease1 and mental health conditions1 to better inform decisionmakers regarding-- 7#a7 primary nonadherence1 including among patients newly prescribed one or more medications at the time of discharge from an acute care setting2 7#b7 medication persistence2 7#c7 related quality measures with respect to medication and methods to improve medication adherence and medication persistence2 and 7#d7 the strategies used by private stakeholders to improve medication adherence among individuals with one or more chronic illnesses4 7b7 ,federal health care programs ,the research conducted1 and information and statistics developed1 under subsection 7a7 7other than paragraph 7#f7 of such subsection7 shall be with respect to individuals treated under the following health care programs3 7#a7 ,the ,medicare program under title ,,xviii of the ,social ,security ,act4 7#b7 ,the ,medicaid program under title ,,xix of the ,social ,security ,act4 7#c7 ,the ,federal ,employees ,health ,benefits ,plan under chapter #hi of title #e1 ,united ,states ,code4 7#d7 ,the ,,tricare program under chapter #ee of title #aj1 ,united ,states ,code4 7#e7 ,hospital care and medical services furnished by the ,department of ,veterans ,affairs under chapters #ag and #ah of title #ch1 ,united ,states ,code4 7c7 ,definitions ,in this section3 7#a7 ,the term medication adherence means a patient taking medications as prescribed by their health care provider1 which may include the prescribed dosage1 time1 frequency1 and direction4 7#b7 ,the term medication persistence means the act of continuing treatment with a medication for the prescribed duration4 7#c7 ,the term primary nonadherence means the failure to fill a newly prescribed medication4 7#d7 ,the term medication management means medical care provided by a health care professional to optimize drug therapy and improve therapeutic outcomes for patients1 including medication therapy management4 7d7 ,reports to ,congress ,the ,secretary shall submit to ,congress an initial report on the research conducted under this section not later than #a year after the date of enactment of this section1 and an updated report not later than #e years after submission of such initial report4 4 #c4 ,linking ,medicare prescription drug and parts ,a and ,b claims data ,section #ahfj;,d-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;c77 is amended by adding at the end the following new paragraph3 7#e7 ,linking prescription drug and parts ,a and ,b claims data 7,a7 ,in general ,notwithstanding any other provision of law1 subject to subparagraph 7,b71 effective for plan year #bjah and each subsequent plan year1 the ,secretary shall1 upon request by the ,,pdp sponsor of a prescription drug plan1 provide the plan with enrollee claims data under parts ,a and ,b1 in order to enable the plan to see the items and services furnished to an enrollee under such parts and to provide greater context for the medication regimen of the enrollee4 7,b7 ,requirements ,the data described in subparagraph 7,a7 shall1 as determined by the ,secretary1 be provided to a prescription drug plan on a regular basis and in a format that is computable and accessible to assist plan efforts in identifying and supporting at-risk enrollees4 4 #d4 ,recognizing medication management improves quality under ,medicare ,advantage and ,prescription ,drug ,plans ,section #aheg7;e7 of the ,social ,security ,act is amended-- 7#a7 in paragraph 7#d71 by striking ,if the ,secretary and inserting ,subject to paragraph 7#e71 if the ,secretary2 and 7#b7 by adding at the end the following new paragraph3 7#e7 ,recognizing medication management improves quality ,for purposes of calculating the minimum medical loss ratio under paragraph 7#d7 for a contract year 7beginning with #bjah71 the ,secretary shall include medication management 7as defined in section #caj;,b7c7 of the ,public ,health ,service ,act7 as part of activities that improve health care quality 7as described with respect to ,medicare ,advantage plans and prescription drug plans in sections #dbb4bdcj and #dbc4bdcj1 respectively1 of title #db1 ,code of ,federal ,regulations 7or in any successor regulation774 4 #e4 ,enhanced medication therapy management model for ,,ma-,,pd plans ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is amended-- 7#a7 in subparagraph 7,a71 by adding at the end the following new sentence3 ,the models selected under this subparagraph shall include the model described in subparagraph 7,d71 which shall be implemented by not later than the date that is #a year after the implementation of the ,part ,d ,enhanced ,medication ,therapy ,management ,model1 as conducted by the ,centers for ,medicare ,medicaid ,services with respect to stand-alone basic prescription drug plans42 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,enhanced medication therapy management for ,,ma-,,pd plans 7i7 ,in general ,subject to clause 7ii71 the model described in this subparagraph is a model to test1 with respect to ,,ma-,,pd plans 7as defined in section #ahfj;,d-#a7;a77#c77;,c771 a model for enhanced medication therapy management that is similar to the ,part ,d ,enhanced ,medication ,therapy ,management ,model1 as conducted by the ,centers for ,medicare ,medicaid ,services with respect to stand-alone basic prescription drug plans4 7ii7 ,no additional performance payment ,under the model described in this subparagraph1 an ,,ma-,,pd plan 7as so defined7 shall not receive any additional performance payment 7other than any applicable percentage quality increase otherwise applicable for the plan under section #ahec7o774 4