More detail about the various MTM amendments that are being considered by the Senate as part of the health care reform package:

1. Hagan Amendment: Senator Hagan (D-NC) has an amendment that is part of a broader amendment package of cost containment and quality measures offered by several Freshmen Dem Senators. The amendment would codify many of the Part D MTM changes proposed by CMS in its 2010 call letter, which are set to go into effect in January. NCPA is supporting this amendment.

2. Akaka Amendment (3109): Senator Akaka (D-HI) has an amendment that would establish a Part D "chronic care management" program for targeted individuals. This is the proposal that PCMA was floating earlier this year. Its a mail order proposal and we are opposing this. The bill also requires accreditation for pharmacies to participate in this program. All pharmacies are state licensed, and requiring pharmacies to obtain accreditation to dispense prescription medications is unnecessary. We understand consumer groups are being asked to endorse this amendment, so we are encouraging calls today into Senate offices to oppose.

3. Menendez Amendment (3110): Senator Menendez's (D-NJ) amendment would create a performance-based payment program for pharmacies in Medicare Part D. The existing Part D MTM program would remain in effect - however, certain patient groups could be eligible to participate in this new program and any willing Medicare Part D pharmacy would be able to participate. Pharmacies would be paid for closing adherence gaps in medication therapy, and the patients could chose the pharmacy they wanted to provide the service. Payments would be made from the Parts A and B Trust Fund, and this program could help demonstrate that prescription drugs and pharmacy services can have an impact on medical spending. While not perfect, we think its another step in demonstrating pharmacy services impact on medical spending, and moves us to a more performance-based model in Part D and maybe in other commercial payers.
Its not clear that any of these will make it into Senator Reid's managers amendment. Alot will depend on the score and any support or opposition.