Therapy Management Program

Medication Therapy Management Program (MTM)

 

MTM Program Purpose

 

The Medication Therapy Management Program (MTM) is designed to help members in all aspects related to the use of medications and optimize therapeutic outcomes. This program improves communication with physicians, healthcare professionals and members in order to achieve integrated care, better use of medications and simultaneously avoid adverse effects or events. It is a free service for eligible members.

 

 

Selection criteria to participate in the MTM Program

 

Members will automatically enter the program if they meet the following three criteria:

 
  • They have spent up to $979.75 in their Part D drug coverage in the last three months or $3,919.00 during the last 12 months.
  • They have been diagnosed with at least three chronic conditions as listed below.
  • They are using at least eight drugs of the selected therapeutic classes (see below).

 

If the member does not want to participate in the program, they can choose not to participate.

 

Members will qualify if they have at least three of the following chronic conditions:

 

  • Chronic Heart Failure (CHF)
  • Diabetes
  • Dyslipidemia
  • Hypertension
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Bone disease/Arthritis-Rheumatoid
  • Bone disease/Arthritis-Osteoarthritis
  • End Stage Renal Disease
  • Asthma

 

The other requirement considered is using at least eight medications covered under Medicare Part D included in the following therapeutic classes:

 

  • ACE-Inhibitors
  • Angiotensin II Receptor Blockers (ARBs)
  • Dyslipidemic Agents
  • Anti-hypertensives
  • Beta Blockers
  • Diuretics
  • Inhaled Corticosteroids
  • Insulins
  • Oral Hypoglycemics
  • Leukotrienes
  • Narcotics
  • Alpha Blockers
  • Antiarrythmics
  • Calcium Channel Blockers
  • Non-steroidal Anti-inflammatory Drugs
  • Digitalis Glycoside
  • Bronchodilators
  • Tumor Necrosis Factors (TNFs)

 

 

MTM Services and Materials

 

 The services provided to the members enrolled in the MTM program include:

 

  • Welcome Letter (through mail), explaining the program in detail
  • Telephone call to the beneficiary or caregiver by an MTM healthcare professional
  • Follow-up evaluation by MTM healthcare professional
  • Annual comprehensive medication review (CMR) to identify drug therapy situations and create a plan to resolve them (through phone and mail)
  • Quarterly targeted medication reviews with follow-up interventions
  • Refill reminders
  • Drug utilization screening
  • Consultations and interventions with prescribing physician to optimize therapy and resolve any medication related situations
  • Patient medication list

 

Download a copy of the Personal Medication List.

 

Once members are included in the MTM Program they will receive a welcome letter and will be contacted via telephone to schedule an appointment for a comprehensive medication review. In case the member is not interested in the program, they may opt out of the program during the call or trough mail. Please note that since not all plan members will qualify for the MTM Program, the program is not considered a benefit.

 

To know more about how to obtain documents related to the program or for more information, please contact our Member Services.

 

Quality Assurance

 

Retrospective Drug Utilization Review

 

This program allows us to intervene on higher risk-related problems. We have pharmacists dedicated to monitoring safety issues, new medication and the pharmaceutical market in general. This program is designed to reduce adverse drug reactions caused by drug therapies. Physicians receive information from patient profiles along with all new findings.

 

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