What is medication therapy management (MTM)?
What is medication therapy management, also known as MTM? MTM is a range of services provided by pharmacists to help improve your health. An MTM session typically includes sitting down with your pharmacist to discuss your medications in depth. These sessions often last 30-60 minutes.
What is a MTM pharmacist?
What is an MTM Pharmacist? The MTM Pharmacist provides patient-centered MTM services for the purpose of optimizing medication therapy to improve clinical, economic and humanistic outcomes. The MTM Pharmacist participates in a broad spectrum of MTM services including, but not limited to, Comprehensive Medication Reviews, Targeted Interventions ...
How do I choose between medication and therapy?
How Do I Choose Between Medication and Therapy? Medications, psychotherapy, and their combination have been shown to help people with emotional or behavioral problems. Different kinds of problems, however, will respond differently to various treatments; therefore, choosing the right treatment can be complicated.
Does Medicaid cover prescriptions?
So the simple answer is yes, Medicaid does cover the costs of prescription drugs. However, this doesn’t mean all prescriptions are completely covered. Each state can choose which medications they are willing to cover and which prescriptions they will not cover. They can also set rules regarding prescription co-payments or shared costs.
Does Medicare Part D cover MTM?
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 the main purpose of MTM?
The goal of MTM is to optimize the therapeutic outcomes of an individual patient as well as detect and prevent costly medication related adverse events.
Who benefits from MTM?
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 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 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.
What types of medication reviews are associated with Medication Therapy Management MTM )?
MTM provided by pharmacists, the medication therapy expert, results in: o A review of all medications prescribed by all prescribers providing care to the patient, and any over-the-counter and herbal products the patient may be taking to identify and address medication problems.
Why do many pharmacies have a policy of pulling any medication off the shelves that will expire in 3 months or sooner?
Why do many pharmacies have a policy of pulling any medication off the shelves that will expire in 3 months or sooner? This ensures that no drugs on the shelves are close to their expiration date.
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.
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 medication management include?
Medication management includes monitoring, reconciling medications, and ensuring patients get the desired outcomes. It requires a thorough review of prescribed drugs and their possible side effects to create treatment plans and monitor their safety and efficacy.
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 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 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.
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.
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 ...
When is Part D required?
Pursuant to 42 CFR § 423.2265(b)(13), Part D sponsors are required by January 1, 2022 to include on their websites a separate section or page about the sponsor’s MTM program that provides the following:
How long does a CMR need to be in CMS?
An individualized, written summary in CMS’ Standardized Format must be provided following each CMR and should be provided within 14 calendar days. This applies whether the CMR is provided to the beneficiary, or to the beneficiary’s prescriber, caregiver, or other authorized representative who may take part in the CMR if the beneficiary cannot accept the offer to participate. The Standardized Format with detailed instructions for implementation, as well as frequently asked questions, are posted on the CMS MTM web page at www.cms.gov > Medicare > Prescription Drug Coverage Contracting > Medication Therapy Management
What chronic conditions are covered by Part D?
However, if sponsors choose to target beneficiaries with specific chronic diseases, they should include conditions from at least five of the following nine core chronic conditions: Alzheimer’s Disease;
What is a CMR in CMS?
An annual CMR with written summaries in CMS’ standardized format. The beneficiary’s CMR must include an interactive, person-to-person, or telehealth consultation performed by a pharmacist or other qualified provider; and may result in a recommended medication action plan.
How often do you need to offer a CMR?
CMS requires that plan sponsors offer a CMR to all targeted beneficiaries at least once every 365 days. CMS expects plans to engage targeted beneficiaries actively and not just passively offer the service.
What is a CMR?
A CMR is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them with the patient, caregiver and/or prescriber.
Can sponsors direct follow up interventions for TMRs?
In contrast to CMRs, sponsors may passively direct follow-up interventions for TMRs towards the targeted beneficiary’s prescriber. Examples include mailed or faxed documentation to the office of the prescriber with suggestions for drug therapy modifications.
