Prescriptions for a Healthy America: A Partnership for Advancing Medication Adherence was convened to raise awareness of the growing challenges posed by medication non-adherence, and advocate for solutions that will help reduce health care costs and improve the lives of patients across the nation through medication adherence interventions.
The partnership believes an integral part of any solution is the use of incentives to improve medication adherence. In particular, new care delivery and payment models should create a structural framework to reward a broad range of healthcare providers (e.g., physicians, nurses, pharmacists) and health plans that improve outcomes and lower costs.
What is the partnership’s role in finding a solution?
We will work closely with elected officials and other key stakeholders to develop policies that help health plans, patients, employers, doctors, pharmacies and other health care practitioners support patients’ medication adherence as a critical part of any treatment plan. We believe there are five key public policy issues that should be addressed by Congress and the administration.
Members of the Partnership will seek legislation and programs that improve medication adherence in the following priority areas:
1. Medicare Synchronization
Medication synchronization is a promising intervention that offers an important opportunity for improving medication adherence by aligning the refill dates for multiple prescription medications. It is currently being tested and operationalized in the private sector but many states have laws that prevent patients from obtaining partial fills, which are required to initially synchronize the medications. P4HA is working with Congress and the Administration to ensure medication synchronization services- which improve outcomes and lower costs- are made available to all patients.
- Test medication synchronization through a Medicare Part D demonstration program.
- Incorporate medication synchronization services into the Federal Employee Health Benefits Program.
- Advocate for the inclusion of medication synchronization in upcoming legislative vehicles.
- Advocate for including medication synchronization in state programs, such as Medicaid and plans on health insurance exchanges.
2. Medication Therapy Management (MTM)
In 2003, the Part D Medication Therapy Management (MTM) benefit was established to provide medication counseling for beneficiaries with multiple chronic conditions, who are on multiple drugs and who spend at least $3100 on those drugs. Experience now suggests that, in order to keep pace with the rapid changes in the health care system, the MTM program is in need of modernization. P4HA is working with Congress and the Administration to develop new standards that more effectively target MTM benefits to beneficiaries in need of services.
- Reform the MTM program by changing eligibility criteria to ensure the benefits are targeted to those in need.
- Ensure that incentives are properly aligned to lower costs and improve outcomes.
- Improve the understanding and evaluation of current and future MTM program effectiveness.
- Advocate for the inclusion of legislative recommendations to modernize the MTM benefit and improve medication adherence in upcoming legislative vehicles.
3. Adherence Safe Harbor
Robust adherence programs, such as patient refill reminders or disease management programs can help patients achieve better health outcomes and contain health care costs. Today, however, health care providers, plans, and drug manufacturers are discouraged from developing and carrying out programs to improve patient adherence, particularly for federal health care program beneficiaries, because of the risk that such programs will implicate the federal anti-kickback statute. A well-designed “safe harbor” to the anti-kickback statute can fill an important gap in the current regulations, which have not been updated in several years. P4HA is developing a safe harbor proposal that removes anti-kickback uncertainties and encourages appropriate adherence interventions with suitable safeguards.
- Advocate for an adherence-specific regulatory safe harbor to the OIG
4. Coordinating Care and Medication Management Services
There are various medication management services offered throughout the Medicare program, but these efforts are ad hoc and not specific to medication adherence. P4HA is developing a plan for coordinating care among the various medication management services (i.e. Comprehensive Medication Management, Medication Therapy Management, Medication Reconciliation, etc.) offered in Parts A, B and D to promote coordination of services.
- Advocate for a demonstration project testing Comprehensive Medication Management (CMM) in Medicare Part B.
- Explore options for developing a common patient identifier across all of Medicare to track medication management interventions and the impact on outcomes.
- Modernize the MTM program.
- Ensure medication management services across all of Medicare are coordinated.
5. Adherence-specific Quality Measures
As the US health system moves from a fee-for-service driven model to value-based reimbursement, it is important to ensure medication adherence improvement strategies are explicitly recognized in these models. P4HA is working with the Pharmacy Quality Alliance to expand and improve the quality and performance improvement measures related to medication adherence in federal and state programs.
- Ensure adherence measures are consistently used across federal programs.
- Develop appropriate new measures to incentivize better adherence through prescribers, pharmacists, and health plans.
6. Health IT Tools
Meaningful Use Stage 3, which focuses on improving outcomes has been postponed until 2017. Medication adherence interventions have the potential to critically reduce health spending and improve health outcomes. P4HA is working with the Administration to promote incentives to adopt and use technologies that promote improved adherence.
- Promote standards that coordinate different EHR functions, such as e-prescribing, medication reconciliation and patient reminders, into a working, electronic adherence-based system.
- Promote the bidirectional exchange of information and interoperability across prescribers, pharmacists, and patients.