Medication Therapy Management (MTM)

Exemplar Health has programs that help members manage their Part D and other medications in special situations. For example, some members have several complex medical conditions at one time. These members may need to take many drugs at the same time, or they could have high drug costs. A team of pharmacists and doctors developed a program for us to help these members with their care. This program is called Medication Therapy Management, or MTM.

Medication Therapy Management (MTM) is a free service for members who take multiple medications for multiple health conditions. MTM can help you and your doctor manage your medications and make sure they’re working to improve your health.

Members who are eligible for the MTMP have:

  1. Who is Eligible for MTM in 2021?
    • Have three or more chronic conditions that may include:
      1. End Stage Renal Disease
      2. Respiratory Disease – Asthma
      3. Chronic Heart Failure
      4. Chronic Obstructive Pulmonary Disease (COPD)
      5. Mental Health – Depression
      6. Diabetes
      7. Dyslipidemia
      8. Hypertension
      9. Bone Disease – Arthritis-Osteoporosis
    • Take seven or more daily medications covered by Medicare Part D 
    • Spend $4,376 or more each year on medications covered by Part D

If you meet the criteria for MTM, we will automatically enroll you in the program. An MTM pharmacist reviews your medication history and sends you a welcome letter indicating you have qualified for MTM. The letter describes any potential medication related problems found during their review and invites you to call for a medication review with an MTM pharmacist. If you decide not to participate, please notify us and we will withdraw your participation in the program.

The pharmacist or pharmacy intern under the direct supervision of a pharmacist will provide the following MTM services with a final goal of helping the member reach the best therapeutic results to fit their needs:

  • An annual Comprehensive Medication Review (CMR) is conducted either by phone or a face-to-face meeting to provide a collection of all the member’s medication related information and address any medication concerns. The CMR will take approximately 45 minutes.
  • A Personal Medication List (PML) to record all prescription and over-the-counter medications which can be updated as needed
  • A Medication Action Plan (MAP) made specific for the member after counseling to help them follow steps while taking medications to reach their health goals
  • The PML and MAP are printed and either mailed or hand delivered within 14 calendar days of the Comprehensive Medication Review
  • Quarterly Targeted Medication Reviews (TMR) which identify potential safety concerns, such as drugs which are not recommended for use in those over age 65, or any drug therapies that the member should be on, but are not, based on their conditions. If issues are identified, a letter is sent to the member and includes ways to help improve medication use. Additionally, a fax communication may be sent to the prescriber.

If the member is unable to participate, an authorized individual may participate on the member’s behalf. In addition, the pharmacist may work with other clinical team members if more services are needed in order to help the member reach their health goals.

If you have questions about the MTM or want to learn more about our program, call us.  We are here to help!

Last Updated on September 14, 2020 by marketing