What is the Medication Therapy Management (MTM) Program?
The Medication Therapy Management (MTM) Program is a free service for members with multiple health conditions and who take multiple medications. This program helps you and your doctor make sure that your medications are working to improve your health.
Who is eligible for the MTM Program?
We will automatically enroll you in the MTM program at no cost to you if you meet the following criteria:
Group 1:
- You have 3 or more chronic diseases. These may include:
- Alzheimer’s Disease
- Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
- Chronic 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)
- You take 8 or more maintenance medications covered by Medicare Part D.
- You spend $1,623 or more per year on Part D covered medications.
Group 2:
- You are part of the Drug Management Program (DMP). This program helps patients who are at risk for prescription drug abuse. If you get opioids from multiple doctors or pharmacies, your plan may talk with your doctors to make sure you need these medications and that you’re using them safely.
We will send you a letter or call to invite you to participate if you qualify.
The program provides you with a:
- Comprehensive medication review and
- Targeted medication review
- Information about the safe disposal of medications that are controlled substances.
Comprehensive medication Review is a one-on-one discussion with a pharmacist or other qualified provider who can answer your questions about the medications you take, including:
- Medications
- Over-the-Counter (OTC) medicines
- Herbal therapies
- Dietary supplements and vitamins
The pharmacist will help you find ways to manage your conditions with the drugs you take. If needed, the pharmacist may contact your prescribing doctor to get more information. The review takes about 20-30 minutes and is usually offered once a year for those who qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List with the medications you discussed during your review.
Here is a blank copy of the Personal Medication List for your reference.
You will also get a Medication Action Plan that outlines the pharmacist’s suggestions so you can talk to your doctor about them during your next visit. The medication action plan includes space for you to take notes or write down any follow-up questions.
Targeted Medication Review, we will mail, fax or call your doctor with suggestions about medicines that may either be safer, or work better than your current medicines. Your doctor will decide whether to consider the suggestions. Your medicines will not change unless you and your doctor decide to change them. We may also contact you by mail or phone with suggestions about your medicines.
Through the MTM Program you’ll get:
- Benefits of discussing your medications with a pharmacist to better understand your medications and use them safely.
- The pharmacist can look for ways to help you save out-of-pocket money on your prescription drug costs.
- A Personal Medication List and a Medication Action Plan that can help you share important information with your doctors and healthcare providers.
Drug Disposal Information, we will send you information about how to dispose of medications that are controlled substances safely.
Taking advantage of the MTM program is voluntary and does not affect your coverage. This program is offered at no cost to you and is open only to those who are invited to participate. The program is not a benefit for all members.
For information about the MTM Program or to see if you qualify, please contact Member Services at: Toll Free Number (844) 969-5366 or Member Local Number (305) 541-5366 (TTY users should call 711), Monday through Friday from 8 am to 8 pm, EST.
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