Medication Therapy Management (MTM) Program
Medication Therapy Management is a distinct service or group of services provided by health care providers, including pharmacists, to ensure the best therapeutic outcomes for patients. It includes five core elements: medication therapy review, a personal medication record, a medication-related action plan, intervention or referral and documentation and follow-up.
A Part D sponsor must have established a MTM program that:
- Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use
- Reduces the risk of adverse events
- Is developed in cooperation with licensed and practicing pharmacists and physicians
- Describes the resources and time required to implement the program if using outside personnel and establishes the fees for pharmacists or others
- May be furnished by pharmacists or other qualified providers
- May distinguish between services in ambulatory and institutional settings
- Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)
According to CMS, each Part D Sponsor is required to incorporate a Medication Therapy Management (MTM) Program into their plans’ benefit structure. Annually, Sponsors must submit a MTM Program description to CMS for review and approval. A CMS-approved MTM Program is one of several required elements in the development of a Sponsor’s bid for the upcoming contract year.
The CDC states that there is strong evidence that the use of MTM by pharmacists is effective. Although the exact combination of MTM activities tends to vary between settings, studies examining MTM have generally found it to be effective and to have strong internal and external validity. MTM trials have been replicated in many different contexts with positive results.
MTM - MEDICATION THERAPY MANAGEMENT
The Medication Therapy Management (MTM) program is an opportunity to have a specially trained MTM pharmacist thoroughly review and maximize the benefits of your medications. This is a free program provided to our members and is not considered a benefit. The MTM program is made up of several different services. For a list and description of these services, please read below.
How can MTM help me?
MTM can help ensure that you receive the absolute best results from your medications while keeping your out-of-pocket costs low.
All PrimeTime Health Plan members are provided with MTM services (TMRs- Targeted medication reviews) that monitor your medications, such as cost-effective alternatives, drug-drug interactions, drug-disease state interactions, medication dosages, and high risk medications in the elderly even if you are not eligible for the CMR program. Those members who are eligible receive these services and more through their participation in the CMR program. By participating in the CMR program, you receive a more personal and interactive medication management, called a comprehensive medication review (CMR) (eligibility required).
To be enrolled for CMR (Comprehensive Medication Review) members must meet the criteria below.
CMR Eligibility Requirements:
- Member must have at least 2 chronic medical conditions, such as bone disease/arthritis/osteoporosis, chronic heart failure, diabetes, high blood pressure (hypertension), or respiratory disease/chronic obstructive pulmonary disease, AND
- Be taking at least five Part D prescription medications, AND
- Have an anticipated annual prescription spending of $4,696 or more in 2022
- Considered an At Risk Beneficiary (ARB)
- Are a member with an active coverage limitation under a drug managed program
Among the services available:
- Comprehensive Medication Review (CMR):
- Your Pharmacist will meet with you face-to-face or via phone to review all your medications. This will help identify any duplications or conflicts and help to organize your medication schedule. Following the CMR, you will receive a Medication Action Plan and Personal Medication List.
- Estimated Time Commitment: 30 minutes to 1 hour
- Prescriber Consult:
- Your Pharmacist will confer with you and your doctor(s), face-to-face or via phone to resolve any problems found with your medications.
- Estimated Time Commitment: 5 to 15 minutes
Medication Adherence Guidance:
Your Pharmacist will ask about how you take certain medications to ensure you take it as prescribed and work with you on any adherence barriers you may encounter.
- Estimated Time Commitment: 5 to 15 minutes
How will I know if I have been enrolled in the CMR program?
You will receive a letter from PrimeTime Health Plan letting you know that you are eligible to receive a Comprehensive Medication Review (CMR). Your letter will let you know who to contact to have your CMR completed. Often it is your current pharmacist. In addition you may also receive a phone call from your pharmacist or another one of our contracted pharmacists to complete your review.
What is a Comprehensive Medication Review (CMR)?
A CMR is a one-on-one meeting with a registered pharmacist. The pharmacist will go over all of your current prescriptions and all of your over-the-counter (OTC) medications such as vitamins, herbs and allergy medications. They will also answer any questions or concerns you have about your current therapies.
The goal of your Comprehensive Medication Review (CMR) is to go over all of your medications to make sure they are the best choices to help you meet your doctor’s health care goals. At the end of your CMR you will receive a Standardized Patient Takeaway. Your Standardized Patient Takeaway will include a Personal Medication List, which will list all of your current medications, and a Medication Action Plan to help you manage the recommendations made during your CMR.
If you would like to schedule a CMR, please read below.
For a more detailed explanation of a CMR, please read below.
What is a Targeted Intervention Program?
Targeted Intervention Program (TIPS) is patient specific program that identifies potential drug therapy problems. The pharmacist will work with the patient and his/her physician to determine the most appropriate action to take. TIPs will work toward providing more cost effective therapy choices for the patient as well as addressing safety, adherence, and proper therapeutic treatment issues for the patient. PrimeTime Health Plan will work with your pharmacist to identify any such issues for you.
For more information about the MTM program, please contact PrimeTime Health Plan Service Center at 330-363-7407 or 1-800-577-5084 or, for TTY users, 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.)
Frequently Asked Questions:
Where can I find an MTM pharmacist?
Contact PrimeTime Health Customer Service to ask if your pharmacist is a registered MTM pharmacist.
How do I know if I qualify for a CMR in the Medication Therapy Management program?
All CMR eligible members will receive a letter and/or phone call from PrimeTime Health Plan or your pharmacist informing them that they have been enrolled and are eligible for a CMR. Your letter will let you know who to contact for your comprehensive medication review.
What if I am not enrolled in the MTM program and would like a Comprehensive Medication Review?
Please contact PrimeTime Health Plan’s Clinical Pharmacist by contacting Customer Service at 330-363-7407 and requesting a call or toll free 1-800-577-5084 or, for TTY users, 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.) and ask to speak to the Clinical Pharmacy team.
Are all pharmacists in the PrimeTime Health Plan network also MTM pharmacists?
Not all pharmacists in the PrimeTime Health Plan network are MTM pharmacists. MTM pharmacists have finished a special training course to provide these extra services. This course is open to any pharmacist. Ask your regular pharmacist if they participate. All of PrimeTime Health Plan’s clinical pharmacists are trained to provide MTM services for you. If your pharmacist is not a registered MTM pharmacist and you would prefer to have them provide you the MTM services, direct them to this page for information on how they can become a registered MTM pharmacist.
Can I use my regular pharmacy and still visit an MTM pharmacist too?
Yes. Your MTM pharmacist does not need to be your regular pharmacist. You may continue to use any PrimeTime Health Plan participating pharmacy for your prescriptions.
Will I pay additional costs for receiving the MTM service?
No. These services are offered to you at no additional cost.
Can the MTM program save me money?
Yes. Similar medications can have large cost differences; your MTM pharmacist can help determine the least expensive, most effective medications for you.
Will my doctor know if any changes need to be made to my prescriptions?
Yes. Your MTM pharmacist may make recommendations to you and your doctor, but only your doctor can change your prescription.
Will I be required to use the MTM program?
No. The MTM program is a free benefit of your membership. We encourage that you take advantage of the program, but you are not required to take part.
What if I do not wish to participate in the MTM Program?
If you wish to opt out of the MTM program benefits you can call PrimeTime Health Plan’s Customer Service and let one of the representatives know that you do not wish to be enrolled in the program.
How do I get started?
Talk to your pharmacist to see if they can provide you with MTM services, or contact PrimeTime Health Plan customer service at 330-363-7407 or toll free 1-800-577-5084 or, for TTY users, 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – March 31st available 7 days a week, 8:00 a.m. to 8:00 p.m.) to find pharmacists in your area who can. You may also schedule a CMR call with an AultCare PrimeTime Clinical Pharmacist by calling Customer Service 330-363-7407 to make that request and a Clinical Pharmacist will return your call.
Primetime Health Plan has contracted with Outcomes MTM to deliver MTM services to eligible members in the community pharmacy setting. The Outcomes-MTM provider network includes chain and independent pharmacies, as well as hospital-based clinical and consultant pharmacists. If you are a pharmacist interested in providing MTM services for Primetime Health Plan members, visit www.outcomesmtm.com
All PrimeTime Health Plan members are provided with MTM services (TMRs - Targeted Medication Reviews) that monitor the safety of your medications, such as cost-effective alternatives, drug-drug interactions, drug-disease state interactions, medication dosages, and high risk medications in the elderly even if you are not eligible for in the Comprehensive Medical Review (CMR) program. Those members who are eligible receive these services and more through their participation in the CMR program. By being participating in the CMR program, you receive a more personal and interactive medication management, such as a Comprehensive Medication Review (CMR).
Free MTM Member Programs include:
- Comprehensive Medication Review
- Targeted Intervention Program
- Identification of lower cost medications for your diagnosis
- Medication synchronization—when possible organize your medications so that you only need to visit pharmacy once per month
- Help in identifying the proper over-the-counter medications
- Help in remembering to take your medications as prescribed and at the most appropriate time of day
What is a CMR?
A CMR is a one-on-one meeting between you and a registered pharmacist. The goal of your CMR is to go over all of your medications to make sure they are the best choices for you and are meeting you and your doctor's healthcare goals. The pharmacist you meet with will often be same pharmacist you currently see to get your prescriptions. The pharmacist will go over all of your current prescriptions with you. They will also talk to you about all of your over-the-counter (OTC) medications like vitamins, herbs, and allergy medications.
Your personalized CMR will be conducted by a certified MTM pharmacist and will include the following:
- A thorough review of all your current prescription, OTC, and herbal medications
- An assessment of medication-related problems, such as:
- Drug-drug interactions
- Drug-disease state interactions
- Medication dosages
- High risk medications in the elderly
- Comprehensive diabetes care
- Medication side effects
- Drug allergies
- Cost-saving alternative therapies
- Disease state management
- Answers to any questions you may have regarding your health
Based on the findings of your CMR, your MTM pharmacist may wish to consult with your doctor on potential changes to your medications; your MTM pharmacist and doctor will work together in order to give you the best medications to help you reach your optimal health. No changes will ever be made without your doctor’s approval.
At the completion of your CMR, you will receive a Patient Takeaway. Your Patient Takeaway includes a Medication Action Plan and a personal medication list.
Your Medication Action Plan is designed personally for you by your MTM pharmacist. This plan outlines for you what steps you can take to reach your healthcare goals, and provides you with the means to track your progress. Your Medication Action Plan includes the following:
- A list of the steps you should take to help you get the best results from your medications
- A blank area for you to document the steps you took to achieve your healthcare goals
- Suggestions made by your MTM pharmacist to improve your health or maximize the benefits of your medications
- A description of any clinical interventions the pharmacist took (working directly with your doctor) to improve your health or medication regimen. Your MTM pharmacist will contact you if there are any changes made to your medications after talking to your prescriber.
Your Patient Takeaway will also include a personal medication list, which is an updated list of all your prescription, OTC, and herbal medications. This list should be provided to you at the time of your CMR or delivered to you immediately afterwards. The list includes the directions and reasons for taking each medication. This is a great reference to have on-hand in the event that you need to go to the hospital or emergency room. The personal medication list allows you to cross out medications that are no longer used and document when and why they were stopped, as well as provides blank rows to easily add new medications that are started. For a complimentary blank medication list, please click here, or contact PrimeTime Customer Service to have one mailed to you.
How do I schedule a CMR?
To see if your current pharmacist is able to provide you with MTM services, contact PrimeTime Health Plan at 330-363-7407 or toll free 1-800-577-5084 or, for TTY users, 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.). PrimeTime Health Plan’s Clinical Pharmacist by calling Customer Service 330-363-7407 to make that request and a Clinical Pharmacist will return your call.
The comprehensive medication review (CMR) can help you create a medication plan and find products to help you reduce your prescription costs. A CMR includes review of your medications, including prescription and over-the-counter products, vitamins, herbals and natural medicines.
After your review, you will receive a list of recommendations that you can discuss with your doctor.
How do I schedule a CMR?
To see if your current pharmacist is able to provide you with MTM services, contact PrimeTime Health Plan at 330-363-7407 or toll free 1-800-577-5084 or, for TTY users, 711, Monday through Friday, 8:00 a.m. to 8:00 p.m. (October 1st – March 31st, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.). Call PrimeTime Health Plan’s Clinical Pharmacist by calling Customer Service 330-363-7407 to make that request and a Clinical Pharmacist will return your call.
Free MTM Member Programs
AultCare Telemonitoring Heart Failure Program is a program that is offered at no cost to all PrimeTime Health Plan congestive heart failure patients. This is an excellent program to help you and your medical team monitor your weight and symptoms. To get started just call 330-363-3956.
AultCare Telemonitoring Diabetes Program is a program that is offered at no cost to all PrimeTime Health Plan diabetic patients. This is an excellent program to help you take control of your diabetes. To get started just call 330-363-2389.
Healthy Diet - Joy Benjamin is a licensed dietitian who would be more than happy to discuss with you manageable ways to improve your diet. Joy can be reached at 330-363-3282.
MTM Patient MAP
PrimeTime Health Plan Customer Service 330-363-3123 or 1-855-281-7561