117 STAT. 2086
PUBLIC LAW 108–173—DEC. 8, 2003 ‘‘(A) A cost-effective drug utilization management program, including incentives to reduce costs when medically appropriate, such as through the use of multiple source drugs (as defined in section 1927(k)(7)(A)(i)). ‘‘(B) Quality assurance measures and systems to reduce medication errors and adverse drug interactions and improve medication use. ‘‘(C) A medication therapy management program described in paragraph (2). ‘‘(D) A program to control fraud, abuse, and waste. Nothing in this section shall be construed as impairing a PDP sponsor from utilizing cost management tools (including differential payments) under all methods of operation. ‘‘(2) MEDICATION THERAPY MANAGEMENT PROGRAM.— ‘‘(A) DESCRIPTION.— ‘‘(i) IN GENERAL.—A medication therapy management program described in this paragraph is a program of drug therapy management that may be furnished by a pharmacist and that is designed to assure, with respect to targeted beneficiaries described in clause (ii), that covered part D drugs under the prescription drug plan are appropriately used to optimize therapeutic outcomes through improved medication use, and to reduce the risk of adverse events, including adverse drug interactions. Such a program may distinguish between services in ambulatory and institutional settings. ‘‘(ii) TARGETED BENEFICIARIES DESCRIBED.—Targeted beneficiaries described in this clause are part D eligible individuals who— ‘‘(I) have multiple chronic diseases (such as diabetes, asthma, hypertension, hyperlipidemia, and congestive heart failure); ‘‘(II) are taking multiple covered part D drugs; and ‘‘(III) are identified as likely to incur annual costs for covered part D drugs that exceed a level specified by the Secretary. ‘‘(B) ELEMENTS.—Such program may include elements that promote— ‘‘(i) enhanced enrollee understanding to promote the appropriate use of medications by enrollees and to reduce the risk of potential adverse events associated with medications, through beneficiary education, counseling, and other appropriate means; ‘‘(ii) increased enrollee adherence with prescription medication regimens through medication refill reminders, special packaging, and other compliance programs and other appropriate means; and ‘‘(iii) detection of adverse drug events and patterns of overuse and underuse of prescription drugs. ‘‘(C) DEVELOPMENT OF PROGRAM IN COOPERATION WITH LICENSED PHARMACISTS.—Such program shall be developed in cooperation with licensed and practicing pharmacists and physicians.
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