NACDS: Medication Management is Key Measurement for Exchange Plans

Published Online: Wednesday, January 22, 2014
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January 22, 2014 (Arlington, Va.) – When selecting an exchange health plan under the Affordable Care Act (ACA), consumers should be able to evaluate plans’ success in medication management, among other quality measures, the National Association of Chain Drug Stores (NACDS) said in comments to the Centers for Medicare & Medicaid Services (CMS).

Specifically, NACDS urged CMS to adopt measures related to medication adherence and appropriate medication use as part of its Quality Rating System (QRS) for Qualified Health Plans (QHPs) which are offered through health insurance exchanges.

The letter emphasized the importance of strong and consistent quality medication measures across federal and state programs to help drive and improve accountability and transparency.  NACDS’ letter also noted the success of medication measures in the Medicare Star Ratings program in driving improved patient outcomes.

Including stronger medication measures will "provide powerful incentives to improve quality of care and patient outcomes, as well as meaningful consumer protections regarding affordable, quality healthcare and meaningful, reliable and actionable rating information," NACDS stated in the letter.

NACDS also emphasized that medication measures are closely linked to improved patient outcomes and lower total medical costs. Citing a recent CMS study within the Medicare Part D program, the letter highlights that medication therapy management (MTM) can lead to improved drug therapy outcomes and significantly reduce catastrophic care and emergency room costs.

NACDS urged the agency to align medication management measures with Medicare as it implements health exchanges. 

To that end, NACDS noted, "Given the beneficial impact of MTM to the Medicare Part D program, we believe MTM should also become the cornerstone of drug coverage in QHPs."

"A lack of alignment on medication management standards undermines consumer education efforts, and diminishes the ability of individuals to have a consistent understanding of the state and federal quality and performance measures with respect to safe, consistent and appropriate medication use," NACDS stated in the letter.

In its continuing efforts in support of MTM, NACDS points to a growing body of evidence that improving medication adherence – including use of MTM to help patients take medications as prescribed – helps to enhance patient health and improve healthcare affordability.

Reports by the Congressional Budget Office (CBO) and the Centers for Medicare & Medicaid Services (CMS), as well as articles in Health Affairs, the Journal of American Pharmacists and the Journal of Managed Care Pharmacy offer further support that appropriate medication use can improve health while lowering costs.

The increasing focus on MTM also has included action in the executive and legislative branches of government.  Earlier this year, CMS published a proposed rule that would improve eligibility criteria for MTM within Medicare, making MTM available to 18 million beneficiaries instead of the current 2.5 million, according to CMS estimates.  Bipartisan support continues to grow for the proposed Medication Therapy Management Empowerment Act of 2013 (H.R. 1024 and S. 557). The legislation enjoys the co-sponsorship of 159 members of the U.S. House of Representatives and 30 members of the U.S. Senate – more than 35 percent of the Congress.

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