Medication Therapy Management (MTM) Program

The Medication Therapy Management (MTM) is a specially defined program outlined by Medicare that helps members ensure the medications they take are safe, necessary, and effective. This program is a free service designed for members who meet certain criteria. You may choose to opt out of the MTM program at any time during the year or you may decline individual services without having to opt out from the program. Call 1-866-686-2223 (TTY 711) to opt out and request to be removed from the program and you will not be contacted again during the calendar year.

You will automatically be enrolled in the MTM program if you meet ALL of the following (3) criteria:

2024 MTM Program Criteria:

1. Take eight or more covered prescriptions, AND
2. Spend $5,330 or more a year on medications, AND
3. Have three or more of the conditions listed below:
   • Chronic Heart Failure (CHF)
   • Diabetes
   • High blood cholesterol
   • High blood pressure
   • Rheumatoid Arthritis (RA)

This service uses a patient centered approach so that eligible members can learn and understand their medications and how to use them safely. Often times we find that our members have multiple prescribing physicians and have medication combinations that may:

• Cause severe side effects
• Reduce the effectiveness of your medications
• Cost you more money per month

Services:

The MTM program offers a Comprehensive Medication Review (CMR) for all eligible members either face-to-face or over the phone. Once enrolled in the program members will receive a welcome letter explaining the benefits of the program. After you receive your letter, you will then be contacted by a partnering local pharmacy, a MTM call center, or a Patrius Health pharmacist about scheduling your medication review. The CMR ranges anywhere from 10 to 30 minutes and is completed annually. A pharmacist or other qualified provider will review your medication history, including prescriptions and over the counter medications, to identify and resolve any medication issues. Any confirmed issues will be communicated to your prescriber. During your review, the provider will answer any questions or concerns you may have regarding your medication and may be able to help you find more affordable options. Once completed, a Medication Action Plan will be mailed out to you that will include steps you should take to get the best results from your medications and a personalized medication list that will help keep track of your medications as well as how you should take them.

All MTM eligible members will also receive a Targeted Medication Review (TMR) in addition to the CMR. The pharmacy claims of all members who qualify will be reviewed every three months to identify any new or persistent drug therapy problems, such as any potential safety concerns, gaps in care such as adherence to chronic medications, as well as omissions in care. If the TMR identifies any issues, the information is communicated to your prescriber via fax or mail with follow up intervention opportunities.

There is no added cost for participating in the program and whether or not you choose to participate has no effect on your insurance benefits. We hope you will participate. Many members tell us they value this personal service and we hope you will too!