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Medication Therapy Management Program (MTMP)

This program is not considered a benefit, but is designed to increase the compliance of medications and to ensure that Beneficiaries are on the most appropriate and cost effective therapy for themselves.

  • MTMP is a required element of the Medicare Part D plan
  • MTMP is coordinated by clinical pharmacists in product management
  • CMS expects this program to become a cornerstone of the Medicare Prescription Drug Benefit
  • MTMP is available to all Medicare Part D Beneficiaries whom meet specific eligibility criteria

Why would a patient receive an MTMP survey and letter? What patients are targeted?
CMS has developed criteria from which the program has been built. The program targets patients based on the following criteria. Patients need to meet all three of the following criteria to be targeted for MTMP.

  • Must have at least three of the following chronic conditions:
    • Asthma/Chronic Obstructive Pulmonary Disease
    • Congestive Heart Failure
    • Depression
    • Diabetes
    • Hyperlipidemia (high cholesterol)
    • Hypertension
    • Osteoporosis (thinning of the bones)
  • Must be taking at least 7 or more maintenance (chronic), part D covered medications.
  • Is likely to incur an annual drug spend of at least $3,000 for all covered Part D medications.

How does the Medicare Part D Medication Therapy Management Program work?
Eligibility into the program is based on prescription information.  Beneficiaries who meet MTM criteria will be sent a letter explaining the program and are requested to return an appointment form. Alternatively, the member has the option to call the MTM call center toll-free to set-up a one-on-one, comprehensive MTM session [Comprehensive Medication Review (CMR)]. Beneficiaries who do not return the appointment form may receive a call explaining the program with the option to transfer to a pharmacist immediately if the member desires to do so.  During the Comprehensive Medication Review, the pharmacists will conduct a comprehensive discussion of all medications (including over-the-counter medications) with the beneficiaries.  Patients will be mailed a list of medications, after this one-on-one session.  Following the comprehensive review session, pharmacists will review beneficiary profiles to identify new or unresolved issues at least every three months.  If the patient is available, one of the reviews will be accompanied by a call to the patient.

For long term care beneficiaries and those beneficiaries who do not respond to letter and phone invitations to engage in a one-on-one, comprehensive MTM session with a registered pharmacist, MTM pharmacists will perform profile reviews to identify medication-related issues and will contact prescribers to address and resolve these concerns.

What type of interactions will occur with Medicare Part D Medication Therapy Management Program patients?
Eligible patients who are interested will receive a one-on-one, comprehensive MTM session [Comprehensive Medication Review] with a clinical pharmacist. Prior to the call, the pharmacist will review the patient’s current therapy for several key items including:

  • Appropriateness of therapy
  • Drug – Drug interactions
  • Under/Over use of medications
  • Possible cost saving opportunities such as generic substitutions
  • Improved compliance opportunities

During the call with the patient, the clinical pharmacist will discuss their findings and suggest ways to improve the patient’s medication therapy. The pharmacist will also review the patient’s non-prescription medications to ensure no interactions are present.  Patients will be mailed a medication list after the one-on-one session with a pharmacist.  Following this session, pharmacists will review beneficiary profiles to identify new or unresolved issues at least every three months.  If the patient is available, one of these reviews will be accompanied by a call to the patient.

What are the goals of the Medicare Part D Medication Therapy Management Program?

  • To ensure optimal therapeutic outcomes associated with the patients’ use of medications (for targeted patients)
  • To perform a comprehensive medication review to identify, resolve and prevent medication related problems, including adverse drug events
  • Provide verbal education and training designed to enhance patient understanding and appropriate use of their medications
  • To recognize drug-drug interactions between the patients medications, any other over-the-counter medications, or herbal medications, in an effort to avoid them
  • To address the use of tobacco in an effort to discourage using tobacco products

What questions might a patient ask about the Medicare Part D Medication Therapy Management Program?

Q. How do I know if I am eligible/how do I enroll?  When will I get a call from a pharmacist?

A. In order to be enrolled in the Medication Therapy Management Program (MTMP), you must meet certain criteria. Upon meeting the specified criteria, you will be automatically enrolled in the program.  Beneficiaries who meet MTM criteria will be sent a letter explaining the program.

Q. Why did I get this letter?

A. After reviewing your prescription history, you met specific criteria that indicated you may benefit from this educational program.

Q. Will this cost me anything?

A. This program is available to you at no cost.

Q. Do I have to do this?

A. This is a voluntary program. You may opt-out if you wish not to participate.

Q. How long will I be enrolled?

A. You will be enrolled through the calendar year. You can be involved every year that you meet the eligibility requirements for that calendar year.

Q. How do I opt-out of the program? 

A. You can choose to stop participating in this free and beneficial program at any time by calling customer service at 1-888-494-2583 from 8 a.m. to 8 p.m. seven days a week. TTY users can call 1-800-377-1363.

Y0010_MK 13121 Approved 12-31-2012
Last updated 11-14-2012