Medication Therapy Management Program

Medication Therapy Management

The Medication Therapy Management (MTM) Program is available for eligible members to help you understand your medications and how to take them safely. Members who qualify for MTM are automatically enrolled in the program, at no cost, and can choose to opt out of MTM. The MTM program is administered by MedImpact.

Eligibility

To qualify for MTM, members must meet Criteria A or B.

Criteria A: must meet ALL THREE (3) of the following criteria

1. Have A diagnosis of at least three (3) chronic conditions from the list below:

  • Alzheimer’s Disease
  • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
  • Chronic congestive heart failure (CHF)
  • Diabetes
  • Dyslipidemia
  • End-Stage Renal Disease (ESRD)
  • Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
  • Hypertension
  • Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
  • Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)

AND

2. Are taking a minimum of eight (8) maintenance drugs

AND

3. Are likely to meet or exceed a cost limit set by the Plan within the previous 3-month period prior to being eligible for the program

Criteria B: You are an at-risk beneficiary

To be considered an at-risk beneficiary, you were previously tagged at-risk and notified by your former prescription drug provider or you are currently taking prescription drugs that are known to have a higher chance of misuse or abuse, such as opioids or narcotics, and you are in one of our drug management programs.  In addition, you are not considered an exempted beneficiary which is defined by any of the criteria below:

1. You have elected to receive hospice care or are receiving palliative or end-of-life care.

2. You are a resident of a long-term care facility, of a facility described in section 1905(d) of the Social Security Act, or of another facility for which frequently abused drugs are dispensed for residents through a contract with a single pharmacy.

3. You are being treated for cancer-related pain. 

4. You have sickle cell disease.

Summary of Services

  • If you qualify for Medication Therapy Management (MTM) Program, you will receive a welcome letter within 60 days. This letter will explain the program, explains how you can request a Comprehensive Medication Review (CMR), and provides instructions if you choose to opt out.
  • A CMR is thorough look at all your medications to make sure there are no harmful interactions between medications.
  • It is an interactive consultation conducted by a pharmacist or other qualified healthcare provider
  • It takes roughly 30 minutes to complete
  • All members who have not opted out of the program receive Targeted Medication Reviews (TMRs) at every 3 months with each update of prescription claims. TMRs may identify potential medication-related needs or issues so that recommendations can be provided.
  • CMRs may also be completed directly over the phone. If the member has an impairment and needs assistance.  The CMR can be performed with the members prescriber, caregiver, or other authorized individual
  • A written summary of the CMR will be mailed to you within 14 days of the CMR completion date.
  • Every year you are MTM eligible and enroll, you will receive comprehensive printed information about safe, appropriate, and cost-effective disposal of prescription drugs that are controlled substances in the same mailing envelope as the MTM welcome letter. The information includes two sites in the beneficiary’s community that participate in drug take-back programs.
  • Members who are in long-term care (LTC) settings are also included in this program. Once eligible for the program, we will attempt to contact you or your caregivers via phone. Or you may request a CMR by calling our partner organization, MedImpact, at 1-800-926-3841 (TTY 711). You may also provide your facility’s contact information to assist in reaching out to you or your caregiver.

Cost of MTM Services

The cost of the MTM program is free for plan members. MTM services are not considered a benefit.

MTM Service Documents and Medication List 

For information on how to obtain Medication Therapy Management (MTM) Program service documents, including the medication list, contact MedImpact Member Services at 1-800-926-3841 (TTY 711).

Contact

For more information, contact MedImpact Member Services at 1-800-926-3841 (TTY 711).