Medication Therapy Management (MTM) Program
Medication Therapy Management (MTM) Program
Medication Therapy Management (MTM) is a program designed to help members take medications safely and effectively. Health Partners Medicare works with SinfoniaRx to provide MTM services from trained MTM pharmacists or other MTM health professionals at no additional cost to you.
The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your provider make sure that your medications are working. It also helps to identify and reduce possible medication problems.
MTM is only available to members who fulfill the criteria outlined below. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems.
We will enroll you in our MTM program if you meet one of the two following criteria:
1. Be an At-Risk Beneficiary as defined by internal drug management program data and/or Medicare Advantage Prescription Drug System (MARx) data
2. Meet ALL of the following criteria:
a) Have at least 3 of these chronic conditions:
- Bone Disease – Arthritis – Osteoporosis
- Chronic Heart Failure (CHF)
- Respiratory Disease – Asthma
- Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD)
b) Take at least 7 chronic/maintenance, covered Part D medications,
c) Are likely to have medication costs of covered Part D medications greater than $4,935 per year.
Health Partners Medicare will also auto-enroll Special (SNP HMO) plan members who take a medication related to the following 3 STAR medication adherence measures:
- Adherence – Diabetes
- Adherence – Hypertension
- Adherence – Cholesterol
All eligible members are automatically enrolled in the MTM program at no cost. However, your participation is voluntary and does not affect Medicare coverage for drugs covered under Medicare. If you meet the criteria, you will receive a letter inviting you to participate in the program and information about the program, including how to access the program.
To help reduce the risk of possible medication problems, the MTM program offers two clinical review types of your medications:
- Targeted Medication Review (TMR): At least quarterly, we will review all of your prescription medications at no cost to you and the MTM pharmacist or other MTM health professional will contact you, your caregiver, your pharmacist, and/or your provider if a medication-related problem or other opportunity to optimize medication use is detected. The MTM pharmacist or other MTM health professional may then consult with you or your caregiver face-to-face or via telephone. The TMR service may take between 5 and 15 minutes.
- Comprehensive Medication Review (CMR): Once per year, we offer a free discussion and review of all your medications by the MTM pharmacist or other MTM health professional to ensure you know why you are taking each medication and to help you take your medications safely. This review, or CMR, is provided to you confidentially via telephone by pharmacies operated by SinfoniaRx. The CMR may also be provided in person or via telehealth at your provider’s office, pharmacy, or long-term care facility. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider. This review takes about 30 minutes to complete. All of your medications including prescription drugs, over-the-counter items, vitamins, and herbal supplements will be reviewed if possible.
Following the CMR, you will get a written summary that you can take with you when you talk with your providers. This summary includes:
- Recommended To-Do List (TDL): This list has steps you should take to help you get the best results from your medications.
- Personal Medication List (PML): This medication list will help you keep track of your medications and how to use them the right way.
Use a blank copy of the Personal Medication List (PML), which can help you and your health care providers keep track of the medications you are taking.
Benefits of the MTM Program
- Personal, comprehensive review of your current drugs
- Assistance with medication-related problems, changes in therapy, and/or opportunities to optimize medication use
For More Information
Getting started is easy. For additional information, please contact Medicare Member Relations at 1-866-901-8000 (TTY 1-877-454-8477).
If you have questions about your personal experience or wish to speak with a SinfoniaRx pharmacist, please call 1-844-866-3735.
MTM Frequently Asked Questions
Why would I use the MTM program?
If you take multiple medications for several chronic health conditions and qualify for the MTM program, the MTM review can help spot possible problems in how your medications work together.
Will I pay any additional costs or fees for the MTM program?
No. This program is offered at no cost to you.
Will I be required to join the MTM program?
All eligible members are automatically enrolled in the MTM program at no cost. However, your participation is voluntary.
What if I do not want to be enrolled in the MTM program?
You can always opt out if you no longer want to receive MTM services when speaking to the MTM pharmacist or MTM health professional or by calling Member Relations department at 1-866-901-8000 (TTY 1-877-454-8477).