To provide for a 1-year medication therapy management assessment program.

1. Adds SEC. ____. MEDICATION THERAPY MANAGEMENT ASSESSMENT PROGRAM at the end of subtitle A of title I

   Adds a section

   In S. 1 · Reported to Senate

   (b) Report.--Beginning with 2007, the Secretary shall submit annual reports to Congress on the study required under subsection (a).

   Inserted: SEC. ____. MEDICATION THERAPY MANAGEMENT ASSESSMENT PROGRAM.

   Inserted: (a) Establishment.--

   Inserted: (1) In general.--The Secretary shall establish an assessment program to contract with qualified pharmacists to provide medication therapy management services to eligible beneficiaries who receive care under the original medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act to eligible beneficiaries.

   Inserted: (2) Sites.--The Secretary shall designate 6 geographic areas, each containing not less than 3 sites, at which to conduct the assessment program under this section. At least 2 geographic areas designated under this paragraph shall be located in rural areas.

   Inserted: (3) Duration.--The Secretary shall conduct the assessment program under this section for a 1-year period.

   Inserted: (4) Implementation.--The Secretary shall implement the program not later than January 1, 2005, but may not implement the assessment program before October 1, 2004.

   Inserted: (b) Participants.--Any eligible beneficiary who resides in an area designated by the Secretary as an assessment site under subsection (a)(2) may participate in the assessment program under this section if such beneficiary identifies a qualified pharmacist who agrees to furnish medication therapy management services to the eligible beneficiary under the assessment program.

   Inserted: (c) Contracts With Qualified Pharmacists.--

   Inserted: (1) In general.--The Secretary shall enter into a contract with qualified pharmacists to provide medication therapy management services to eligible beneficiaries residing in the area served by the qualified pharmacist.

   Inserted: (2) Number of qualified pharmacists.--The Secretary may contract with more than 1 qualified pharmacist at each site.

   Inserted: (d) Payment to Qualified Pharmacists.--

   Inserted: (1) In general.--Under an contract entered into under subsection (c), the Secretary shall pay qualified pharmacists a fee for providing medication therapy management services.

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   Inserted: (2) Assessment of payment methodologies.--The Secretary shall, in consultation with national pharmacist and pharmacy associations, design the fee paid under paragraph (1) to test various payment methodologies applicable with respect to medication therapy management services, including a payment methodology that applies a relative value scale and fee-schedule with respect to such services that take into account the differences in--

   Inserted: (A) the time required to perform the different types of medication therapy management services;

   Inserted: (B) the level of risk associated with the use of particular outpatient prescription drugs or groups of drugs; and

   Inserted: (C) the health status of individuals to whom such services are provided.

   Inserted: (e) Funding.--

   Inserted: (1) In general.--Subject to paragraph (2), the Secretary shall provide for the transfer from the Federal Supplementary Insurance Trust Fund established under section 1841 of the Social Security Act (42 U.S.C. 1395t) of such funds as are necessary for the costs of carrying out the assessment program under this section.

   Inserted: (2) Budget neutrality.--In conducting the assessment program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the assessment program under this section was not implemented.

   Inserted: (f) Waiver Authority.--The Secretary may waive such requirements of titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 1395 et seq.) as may be necessary for the purpose of carrying out the assessment program under this section.

   Inserted: (g) Availability of Data.--During the period in which the assessment program is conducted, the Secretary annually shall make available data regarding--

   Inserted: (1) the geographic areas and sites designated under subsection (a)(2);

   Inserted: (2) the number of eligible beneficiaries participating in the program under subsection (b) and the level and types medication therapy management services used by such beneficiaries;

   Inserted: (3) the number of qualified pharmacists with contracts under subsection (c), the location of such pharmacists, and the number of eligible beneficiaries served by such pharmacists; and

   Inserted: (4) the types of payment methodologies being tested under subsection (d)(2).

   Inserted: (h) Report.--

   Inserted: (1) In general.--Not later than 6 months after the completion of the assessment program under this section, the Secretary shall submit to Congress a final report summarizing the final outcome of the program and evaluating the results of the program, together with recommendations for such legislation and administrative action as the Secretary determines to be appropriate.

   Inserted: (2) Assessment of payment methodologies.--The final report submitted under paragraph (1) shall include an assessment of the feasibility and appropriateness of the various payment methodologies tested under subsection (d)(2).

   Inserted: (i) Definitions.--In this section:

   Inserted: (1) Medication therapy management services.--The term "medication therapy management services" means services or programs furnished by a qualified pharmacist to an eligible beneficiary, individually or on behalf of a pharmacy provider, which are designed--

   Inserted: (A) to ensure that medications are used appropriately by such individual;

   Inserted: (B) to enhance the individual's understanding of the appropriate use of medications;

   Inserted: (C) to increase the individual's compliance with prescription medication regimens;

   Inserted: (D) to reduce the risk of potential adverse events associated with medications; and

   Inserted: (E) to reduce the need for other costly medical services through better management of medication therapy.

   Inserted: (2) Eligible beneficiary.--The term "eligible beneficiary" means an individual who is--

   Inserted: (A) entitled to (or enrolled for) benefits under part A and enrolled for benefits under part B of the Social Security Act (42 U.S.C. 1395c et seq.; 1395j et seq.);

   Inserted: (B) not enrolled with a Medicare+Choice plan or a MedicareAdvantage plan under part C; and

   Inserted: (C) receiving, in accordance with State law or regulation, medication for--

   Inserted: (i) the treatment of asthma, diabetes, or chronic cardiovascular disease, including an individual on anticoagulation or lipid reducing medications; or

   Inserted: (ii) such other chronic diseases as the Secretary may specify.

   Inserted: (3) Qualified pharmacist.--The term "qualified pharmacist" means an individual who is a licensed pharmacist in good standing with the State Board of Pharmacy.

   Original wording

   At the end of subtitle A of title I, add the following:

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As printed