Medication Therapy Management
Medication Therapy Management Core Elements
Medication Therapy Management (MTM) Programs are required by the Centers for Medicaid and Medicare Services (CMS) for all Part D Prescription Drug Plans (PDP) and Medicare Advantage Plans (MA). This valuable program is offered free of charge and is not considered a benefit. There are no additional co-pays or charges.
How do I benefit from MTM?
- Each medication the doctor prescribes is reviewed by an MTM trained Pharmacist when the prescription is filled.
- This review helps the patient get the greatest benefit from the medication.
- This also helps reduce the risk of harmful side effects.
- The pharmacist can suggest alternatives that can lower the patient’s costs.
- The patient will receive a Comprehensive Medication Therapy Review (CMR) at least annually. The CMR usually takes about 30 minutes to complete.
How will the patient be offered MTM services?
MTM Eligible patients are contacted via mail and/or phone to offer MTM services.
MTM eligible patients are contacted telephonically on a monthly basis to remind them of the importance of the Comprehensive Medication Review (CMR).
These monthly reminders continue until the member completes a CMR or notifies the plan they do not want to be called again. Members may also be contacted directly by their local pharmacy.
MTM Services may be conducted in person at the member’s local pharmacy or telephonically with the local pharmacy or the health plan.
CMRs are conducted at least annually and usually take about 30 minutes to complete.
Targeted Medication Reviews (TMR) are conducted quarterly in person at the member’s local pharmacy or telephonically with the local pharmacy or with the health plan.
The TMR usually takes 5 or 10 minutes and covers important issues regarding medication use.
Some examples are: adherence to medications, side effects, drug interactions, over and/or under-utilization, or medications that may be associated with higher risk in the elderly.
What is my Comprehensive Medication Review (CMR)?
A Comprehensive Medication Review (CMR) is a consultation with a qualified pharmacist and goes over the following:
- Why each medication is prescribed and whether any medications are potentially unnecessary.
- If each medication is effective.
- If each medication could be causing side effects, worsening other health conditions, or interacting with other medications.
- If a medication regimen can be made more affordable or simplified (such as fewer pills or a more convenient dosing schedule).
- If medications are being taken appropriately to get the most benefit from them.
After your CMR has been completed, you will be provided with two documents via the mail:
A Medication Action Plan (MAP):
Includes steps you should take to get the best results from your medications.
A Personalized Medication Record (PMR):
Helps you keep track of your medications and how to use them properly.
CENSON Health Services
MTM Programs are required by CMS to include patients that meet the following requirements:
- Incur one-fourth of specified annual cost threshold ($4,696) in previous three months
- Multiple chronic diseases
- Multiple medications
Participation is voluntary, and patients are given the opportunity to dis-enroll (opt-out) at any time. This program is not considered a benefit.
- Medicare patients must have any three (3) of the chronic medical conditions listed below:
a) Chronic Heart Failure (CHF)
e) Respiratory Disease-Asthma
f) Respiratory Disease-Chronic Lung Disorders
g) Respiratory Disease-Chronic Obstructive Pulmonary Disease (COPD)
- The Medicare patient must receive a minimum of eight (8) chronic/maintenance Part D medications per month.
- The Medicare patient must incur one-fourth of the specified annual cost threshold ($4,696) in the previous three months
- Medicare patients eligible for the MTM program will be enrolled automatically. Participation is voluntary and members are given the opportunity to dis-enroll (opt-out) at any time
- At any time, a beneficiary, a beneficiary’s representative or beneficiary’s physician may request that they not participate in this program, and they will no longer be enrolled/eligible. Members will also be dis-enrolled if they leave the Plan. Please Note: Disenrollment from the MTM program does not disenroll you from your health plan.