What is the MTM program?
• MTM. focuses on ongoing management of the patient’s entire medication regimen with a concentration on optimizing therapeutic effectiveness, preventing adverse events and achieving optimal medication therapy goals.
Is MTM covered by Medicare?
MTM as a part of the Medicare Part D Drug Benefit of PDPs and MA-PDs. Medicare Part D Prescription Drug Plans (PDPs) and Medicare Advantage Plans (MA- PDs) must have MTM programs that provide appropriate services to targeted beneficiaries to optimize therapeutic outcomes.
What is a medication therapy management program (MTMP)?
Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP) Each Part D Sponsor is required to incorporate a Medication Therapy Management Program (MTMP) into their plans' benefit structure. Annually, Sponsors must submit a MTMP description to CMS for review and approval.
Who will benefit from MTM services?
While all patients who take medications stand to benefit from MTM services, at least the following changes to the Medicare program that enhance pharmacist-provided MTM services should be implemented now:
What is an MTM program?
Medication therapy management (MTM) is a distinct service or group of services provided by health care providers, including pharmacists, to ensure the best therapeutic outcomes for patients.
What part does Medicare cover MTM?
Part D coverageGet help managing your medications Medication Therapy Management (MTM) services are offered at no additional charge to Medicare Advantage plan members with Part D coverage who meet Centers for Medicare and Medicaid Services (CMS) criteria.
What is a MTM payment?
MTM Currency is a program that provides gas mileage reimbursement through a Focus Card™. This is a reloadable debit card issued by U.S. Bank.
What is a targeted medication review?
A targeted medication review (TMR) is an ongoing monitoring process with outreach made to the patient and/or prescriber about a specific or potential medication-related problem, without a comprehensive assessment of the patient's medications.
Who benefits from MTM services?
People who may benefit the most include those who use several medications, those who have several health conditions, those who have questions or problems with their medications, those who are taking medications that require close monitoring, those who have been hospitalized, and those who obtain their medications from ...
How do you complete a MTM?
Ten Tips for MTM successTalk to other healthcare providers. ... Provide incentives. ... Get the staff involved. ... Think about the patient. ... Document, document, document. ... Communicate well. ... Market MTM. ... Take advantage of technology.
What is a factor when determining a patient's eligibility for MTM services?
The Patient Protection and Affordable Care Act (PPACA) laid out a set of MTM eligibility criteria for eligible entities to target patients for MTM services: “(1) take 4 or more prescribed medications …; (2) take any 'high risk' medications; (3) have 2 or more chronic diseases… or (4) have undergone a transition of care ...
What are the two critical aspects of MTM services?
MTM services include providing education and counseling, improving medication adherence, and detecting adverse drug events and medication misuse.
How is MTM billed?
To calculate the amount of time that is reimbursable for prolonged outpatient services, take the total face-to-face time and divided by 15 minutes. The first 15 minutes of each session is billed using either 99605 or 99606, additional time is billed using 99607. MTM sessions may not exceed one hour per session.
What is the difference between MTM and CMR?
Background: Medication therapy management (MTM) programs are designed to improve clinical outcomes and enhance appropriate medication use. Comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) are 2 broad interventions defined within MTM services.
What does PMR mean in pharmacy?
The major piece of technology used to support pharmacists in delivering pharmaceutical care is the Patient Medication Record (PMR) system, which is now widely used to manage patient care.
What is the MTM consultation?
As part of your consultation, the MTM provider may: Send you a summary of your consultation that includes the Personal Medication List, which is a list of all of the medications you're taking, and a Medication Action Plan, which includes things that you talked about with the MTM provider.
What is medication therapy management?
What is the Medication Therapy Management program? One-on-one review with a pharmacist or other trained health care provider. Medication Therapy Management (MTM), while not part of a prescription drug benefit, is a Medicare designed program sponsored by Humana's RxMentor program. By participating in the program we want to help you get ...
What can a trained provider do to help you make sure your medications are working for you?
When you talk to a trained provider they can help you make sure your medications are working for you, may help you find lower cost options, and answer any questions or concerns you may have about your medications.
What is the number to call for Medicare?
You may also call us at 1-888-686-4486 (TTY: 711). Representatives are available Monday through Friday, 8 a.m. to 7 p.m. EST. Although the MTM program is a special service offered at no cost to Medicare members, it is not considered a benefit.
Can you take multiple Humana medications?
If you're like many of Humana's Medicare members, you're taking multiple medicines prescribed by more than one doctor. You could also be taking medicines that, when combined, may: Reduce the effectiveness of your medicines. Cause severe side effects. Cost you more money per month.
Does Humana cover Medicare Part D?
As part of your Medicare Part D coverage with Humana, you can set up a one-on-one review of your medicines with a pharmacist or other trained health care provider. This review is called a comprehensive medication review (CMR) and is offered at no extra cost to you. Once enrolled in the program, you or your prescriber may be contacted about ...
Can the Medication Therapy Management (MTM) Program help you with your medications?
If you receive your Medicare Part D drug coverage through Tufts Health Plan Medicare Preferred, you may be eligible for a Medication Therapy Management (MTM) program.
What is the MTM program?
The MTM program was created to help us provide better care for our members. We have partnered with Outcomes MTM to provide this important service. Specially trained pharmacists, from a pharmacy call center (such as MedWatchers or CHC Health), will work with you and your doctor to make sure that your medications are appropriate, safe, and effective.
Who is it for?
Enrollment in this program is automatic if you meet specific criteria based upon:
MTM Program Criteria
As a member of Tufts Health Plan Medicare Preferred, you will be automatically enrolled in the Medication Therapy Management (MTM) program if you meet the following criteria:
What is a Comprehensive Medication Review?
The Comprehensive Medication Review or “CMR” is done over the phone by a pharmacist or other qualified provider. Your medication history (prescription and over-the-counter), lifestyle, and medical history will be reviewed. Based on this information, the pharmacist may offer recommendations or suggestions related to medication therapy.
For More Information
For additional information regarding Tufts Health Plan Medicare Preferred’s MTM Program, please contact our Customer Relations department. HMO members should call 1-800-701-9000 (TTY: 711). Senior Care Options members should call 1-855-670-5927 (TTY: 711).
What is the Medication Therapy Management Program?
The Medication Therapy Management (MTM) Program is a part of Cigna Medicare Part D Prescription Drug Plans and Cigna Medicare Advantage Plans (Part C) with prescription drug coverage.
How do I get started?
Cigna Medicare customers who qualify for the MTM Program are automatically enrolled 1 and sent a welcome packet in the mail.
How much will this program cost me?
There is no extra cost for this program. While it’s not seen as a Medicare benefit, the MTM Program is part of the plan you select for coverage.
What if I have questions?
If you have questions or need more information, please call the Cigna Medicare MTM Program toll-free:
How to contact my MTMcare pharmacy?
Check if you are eligible. Simply call the Customer Service line at 1-800-777-4376 (TTY/TDD line at 1-800-947-3529).
How long does it take to get a CMR?
This will help identify any duplications or conflicts, as well as help organize your medication schedule. The CMR service may take between 30 minutes to one hour. Following the CMR, you will receive a Medication Action Plan and Personal Medication List.
Can you opt out of MTM?
Eligible members can opt out of the MTM program, as participation is voluntary. Although the MTM program is a special service offered at no cost to our Medicare members, it is not considered a benefit. H2237_IC2203_M. Last Updated 1/4/21.
What is MTM in healthcare?
MTM encourages patients to be active participants in their health care, empowering them to be more knowledgeable about and responsible for their health and medication use. MTM services facilitate a more effective partnership among patients, their pharmacists, physicians, and other health care providers to achieve optimum medication therapy results.
Is Medicare Part D a MTM?
As currently structured, Medicare Part D prescription drug plan incentives are misaligned for providing robust MTM services. While MA-PD plans may immediately benefit from MTM services through a reduction in overall health care costs (e.g., medical visits & hospitalizations) for which they are at risk in addition to medications, stand-alone PDPs have minimal incentive to offer comprehensive MTM programs that offer the most beneficial outcomes for patients.x Pharmacist-provided MTM often improves adherence and compliance with established medication regiments and treatment guidelines, thus potentially increasing medication consumption, and costs, while decreasing overall health expenditures. PDPs that are at risk only for the costs of beneficiaries’ drug expenditures may be hesitant to provide a robust MTM program that could adversely impact their bottom line, despite the overall benefit for the patient and for the health care system.
