If you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.
The MTM program is a service offered at no additional cost to you. These services are provided in line with CMS guidelines and are not considered a benefit.
You'll be automatically enrolled in this program if you meet the three requirements below.
1. Have at least three of the following conditions or diseases:
2. Take at least eight covered Medicare Part D medications.
3. Are likely to have greater than $5,330 per year in covered Medicare Part D medication costs.
You'll be automatically enrolled in this program if you're in a drug management program that defines a specific drug dose, pharmacy or doctor.
The MTM program gives you a comprehensive medication review and a targeted medication review.
Comprehensive medication review
To help reduce the risk of possible problems, our MTM program offers two types of clinical review:
Targeted medication review: At least every three months, we'll review all of your prescription medications. If we find a concern relating to safety or cost, we may contact your doctor.
Comprehensive medication review (CMR): To help you safely use medications and ensure they're working to improve your health, we offer a free annual review by a pharmacist or other health professional. The pharmacist will meet with you face-to-face or via phone to review your prescriptions, vitamins, herbals, supplements and other over-the-counter medications. The pharmacist looks for potential medication conflicts, duplications, side effects or ways to save you money. You can ask any questions you have about your medications. After the review, the pharmacist will work with you, and your doctor if necessary, to resolve any medication-related concerns. It takes about 20 minutes. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:
oRecommended To-Do List (TDL): The list has steps you should take to help you get the best results from your medications.
oPersonal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.
To help members get the best results from their medications, Medica contracts with Express Scripts to receive Medication Therapy Management Services from OutcomesMTM™, a Cardinal Health company, to eligible Medica members.
If you're eligible, we'll send you a letter to let you know you've been automatically enrolled. It will include information about the MTM program, including contact information and instructions to opt out if you choose. To get more information or opt out, call Medica Member Services at the number on the back of your Medica ID card. TTY users, call 711.