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Bill Seeks to Help Medicaid Recipients Manage Their Medications

Measure would require payments to pharmacists to help patients keep track of prescriptions.

Pharmacists would help Medicaid recipients in New Jersey manage their prescriptions, under a bill advancing in the Legislature.

The measure,S-2568/A-3716, would require that Medicaid recipients be covered for medication therapy management, a set of services in which a pharmacist reviews patients’ medications and develops a plan to address problems that might arise from taking multiple medications.

While residents who are at least 65 years old are eligible for these services under the Medicare Part D prescription drug program, younger low-income residents who rely on Medicaid aren’t eligible.

The bill aims to address the increased number of patients taking many different medications, requiring more thorough consultations with pharmacists than were traditionally available. Medication therapy management, or MTM, has reportedly prevented 1.5 million events that could have resulted in injuries or deaths.

“Pharmacists provide medication therapy management to help patients get the best benefits from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems,” according to the American Pharmacists Association.

Pharmacists providing the service review all medications, vitamins and herbal supplements that patients are taking and develop a plan for ensuring patient safety and avoiding inconsistencies, duplication, omissions and unnecessary costs. The plan is communicated to patients and their doctors.

The services are intended for patients who have a complex set of medications and chronic conditions. Under the bill, any patient with three or more medications and two or more chronic conditions would be eligible for the services.

Medicaid currently provides insurance to 1.3 million state residents, primarily through New Jersey FamilyCare. An additional 234,000 are expected to join the program after Gov. Chris Christie decided to support Medicaid expansion under the 2010 Affordable Care Act.

The legislation has drawn concern from insurance industry advocates, who say that the bill would overwhelm the system. Wardell Sanders, president of the New Jersey Association of Health Plans, noted that the Medicare program currently provides MTM only for patients who are taking at least eight medications and have at least three conditions.

“We’re concerned that you’re going to overwhelm the program and not have it achieve its goals,” Sanders said. “That’s why we’d like to see this more along the lines of the Medicare model.”

However, Sanders lauded the concept behind MTM

“We’re very supportive of the goals of this legislation, to optimize drug therapy with the intent of improving therapeutic outcomes,” Sanders said. “MTM has proven to be effective under Medicare and even without this bill, there is a movement nationally among Medicaid plans and here in New Jersey involvement of MTM or MTM-like services.”

Sanders supported having state regulators determine who would be eligible for MTM and proposed that the amount of services required under the bill – including a requirement that MTM consultations be done in person – be relaxed.

Bill sponsor Sen. Joseph F. Vitale (D-Middlesex) said he is willing to work with Sanders to try to reach a compromise.

Sen. Robert W. Singer (R-Monmouth and Ocean) said he applauded the bill’s goals, noting that seniors can become overwhelmed by the number of medications they take.

“Conceptually, we’re all on the same page,” adding that he understood Sanders’ concerns about the bill.

The Senate Health, Human Services and Senior Citizens Committee released the bill on Monday, with nine votes in favor and Sen. Dawn Marie Addiego (R-Atlantic, Burlington and Camden) abstaining. The Assembly version of the bill is scheduled for a hearing with the Assembly Health and Senior Services Committee on Thursday.

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