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

1. Qualifying members for MTM must meet ALL THREE (3) of the following criteria:

  • 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

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.
  • 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.
  • A written summary of the CMR will be mailed to you within 14 days of the CMR completion date.
  • 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).