2018 Medication Therapy Management Program
Spend less time worrying about your medicine and more time enjoying life with the Medication Therapy Management (MTM) Program. The Plan has partnered with OutcomesMTM™ to provide this free service for eligible Medicare Part D members through their local pharmacies.
What is MTM?
The Medication Therapy Management (MTM) program is not considered a plan benefit and is a free personalized service offered as part of the Medicare Part D program for plan members. It is designed to optimize your health outcomes by having community pharmacists work directly with you and your healthcare provider. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS). The purpose of the program is to:
- Address safety concerns regarding your medications, such as allergies, side effects and drug-drug interactions (complications)
- Provide you with options for potentially more cost effective medications (to be discussed with your prescriber)
- Improve your adherence to your medications and improve your compliance with established care guidelines
To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, you will be invited to participate in the program and we will send you information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.
How Can I Participate in the MTM program?
To qualify for the MTM program, you must meet the following three criteria:
- You have at least two of the following conditions or diseases:
- Alzheimer's Disease
- Bone Disease-Arthritis (Osteoporosis)
- Bone Disease-Arthritis-Rheumatoid Arthritis
- Chronic Heart Failure (CHF)
- Dyslipidemia (High Cholesterol)
- Hypertension (High Blood Pressure)
- Mental Health (Depression)
- Respiratory Disease-Asthma
- Respiratory Disease (Chronic Obstructive Pulmonary Disease [COPD])
- Chronic Non-Cancer Pain
- Chronic Alcohol or other Drug Dependence
- Hepatitis C
- Multiple Sclerosis
- You take at least six covered chronic/maintenance Medicare Part D medications
- You are likely to have medication costs of covered Part D medications greater than or equal to $3,967 per year, calculated quarterly
What services are offered through the MTM Program?
If you qualify for the MTM Program, you will have the opportunity for a one-on-one in person medication review or a phone call with a pharmacist to discuss and review your medication(s) at no charge to you. This one-on-one medication review can take from 15-45 minutes to complete. During this review, you will:
- Talk about side effects that may make it hard to take your medicine
- Suggest the best ways to take your medicine
- Answer any questions you may have regarding your medications
You will get a written summary of this Comprehensive Medication Review (CMR) to help you get the most from your medications. You can take this summary with you when you talk with your doctor(s). Additional services, such as Targeted Medication Reviews (TMR), are offered to both you and your doctors, which are aimed to improve your health. Additionally, you may obtain a blank Personal Medication List (PML) to assist you in organizing your medications by clicking here.
Through the MTM Program, you will receive:
- Individualized written summary of your Comprehensive Medication Review (CMR)
- Medication Action Plan (MAP) with tips on how to take your medicine(s)
- Personal Medication List (PML) that lists your medicine(s)
How Our Program Works
- If you meet the three eligibility criteria listed, you will be automatically enrolled in the program.
- When you receive a letter informing you of your inclusion in the MTM program, you will have the option to OPT OUT- your participation is up to you.
- You will receive an automated call from our MTM program partner when you are enrolled in the program.
- You may receive a phone call from your pharmacy or another local pharmacy, who is our partner in providing you this service, to schedule a Comprehensive Medication Review (CMR).
- Your medications may be monitored on a regular basis to ensure safe and effective utilization. These are called Targeted Medication Reviews (TMR). You don't have to do anything to receive these medication reviews.
- If you have questions about the MTM program, contact the Plan’s Customer Service at 1-866-789-7747
Qualify for MTM based on meeting 3 criteria above
Receive your Welcome Letter in the mail
Set up your one-on-one visit with a pharmacist
Pharmacist consults you on the use of your medication(s)
Receive written summary, Medication Action Plan and Personal Medication List
If you would like more information or have questions, please call the Plan’s Customer Service at 1-866-789-7747