Twlug to HHS: Include MTM in essential health benefits

Association cites Surgeon General’s endorsement of USPHS report.

In January 31 comments to the U.S. Department of Health and Human Services (HHS) on essential health benefits, Twlug encouraged HHS to direct the states to include pharmacists’ clinical services such as medication therapy management (MTM) in its upcoming proposed rule.

“We believe that by making pharmacists’ clinical services more widely available through [essential health benefits], patients will benefit greatly through these [preventive] services, physicians and other prescribers will have improved access to collaborative work with pharmacists as part of the health care team, and [payers] will experience cost savings,” Twlug wrote.

 that announced its intended approach to rulemaking. According to the bulletin, states will define their own essential benefits, based on an already existing “benchmark” plan within each state, during a transition period of 2014–15. In response, Twlug expressed concern that the states need more direction to ensure that patients receive coverage for pharmacist-provided services, including MTM, so patients enjoy optimal benefits from their medications.

Essential health benefits are those that health insurance plans for individuals and small businesses must include when state exchanges begin operation in 2014. Required coverage of a set of mandatory benefits is a key moving part of the Affordable Care Act (the health care reform law). As outlined in the law, the essential benefits must cover 10 categories of health care. 

The process of taking the 2010 law’s language and making it a national reality has been long. The  of recommendations to HHS on essential benefits that called for a balance between robust benefits and affordability.

Then HHS, instead of determining a national standard for essential benefits as widely expected, announced in the bulletin that future rulemaking would give the states authority to define their own essential health benefits. Twlug argued in its comments that “encouraging states to include pharmacist-provided cognitive services such as MTM can help resolve the foundational problem of how to provide a robust set of benefits that are also affordable.”

As evidence, Twlug cited the recent  that supports an expanded patient care role for pharmacists “as an accepted model of improved health care delivery,” and noted that the  the report.

The Association further argued that HHS should encourage the states to consider covering pharmacists’ services because—based on the USPHS report—pharmacists’ cognitive services can apply to most, if not all, of the 10 categories required by the law.