2022 Medication Therapy Management Program

Can the Medication Therapy Management (MTM) Program help you with your medications?

When you have chronic health conditions, prescription drugs can be a big part of your life. The Medication Therapy Management program can help make sure you’re getting the most benefit from the drugs you take.

What is the MTM program?

If you qualify for the MTM program, you are eligible for an annual Comprehensive Medication Review (CMR) with a specially trained pharmacist who can help:

• Ensure you’re getting the most benefit from the drugs you take
• Identify potential drug-to-drug interactions (including with your over-the-counter medications)
• Offer solutions that may decrease side effects from your medications
• Simplify your medication regimen
• Identify less expensive medication alternatives

This program is not considered a benefit and is a free service for eligible beneficiaries. Participation in the program is always voluntary and you may choose not to participate or disenroll at any time.

Who is it for?

If you receive your Medicare Part D drug coverage through Tufts Health Unify, you may be eligible to participate in the Medication Therapy Management (MTM) program. Enrollment in this program is automatic if you meet specific criteria based upon:

• The number of certain chronic conditions you may have
• The number of covered Part D medications you may take
• The estimated annual cost for your covered Part D medications

2022 MTM Program Criteria

As a member of Tufts Health Unify, you will be automatically enrolled in the MTM program if you meet the following criteria:

1. You have at least three (3) of the following chronic conditions:
   • Diabetes mellitus
   • Chronic obstructive pulmonary disease (COPD)
   • High blood pressure (hypertension)
   • High cholesterol (dyslipidemia)
   • Congestive heart failure (CHF)
   • Asthma
2. You have claims for eight (8) or more different covered Part D medications
3. You have at least $4,696 in estimated annual drug costs for covered Part D medications

If you are eligible for the MTM program, you will receive a welcome letter from our MTM partner, OutcomesMTM. Within a few weeks of receiving the letter, you will receive a call from one of OutcomesMTM’s call center pharmacies (MedWatchers or CHC Health) to set up an appointment to speak to a clinical staff member and to complete the Comprehensive Medication Review (CMR). We encourage you to take full advantage of this service.

What is a Comprehensive Medication Review?

The Comprehensive Medication Review, or “CMR”, is done over the phone by a pharmacist. During this time, you will be able to review your medication history (prescription and over-the-counter), lifestyle, and medical history. Based on this information, the pharmacist may offer recommendations or suggestions related to medication therapy. Then, a Medication Action Plan (MAP) summarizing any concerns and a Personal Medication List (PML) is sent to you by mail within 14 days. This information, along with any recommendations, is also sent to your physician. A CMR for all eligible members is done at least once a year and should take between 15-20 minutes.

In addition to the CMR, Targeted Medication Reviews (TMR) are conducted four times a year. During a TMR, the Pharmacist will assess your medication use and monitor for any new potential drug therapy issues. Any recommendations that are identified, will be sent to your Physician.

Tufts Health Unify members: 

Click here to print a blank copy of the Personal Medication List to keep for your records and share with your provider. You may also contact our member services team to request a copy. 

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Disclaimers

Tufts Health Unify is a health plan that contracts with both Medicare and MassHealth to provide benefits of both programs to enrollees. It is for people with both Medicare and MassHealth ages 21 through 64 at the time of enrollment.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook (2022).

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-855-393-3154 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. The call is free.

Si habla español, tiene disponible los servicios de asistencia de idioma gratis. Llame al 1-855-393-3154 (TTY: 711), siete días de la semana, de 8 a.m. a 8 p.m. La llamada es gratuita.

You can get this document for free in other formats, such as large print, formats that work with screen reader technology, braille, or audio. Call 1-855-393-3154 (TTY:711), seven days a week, from 8 a.m. to 8 p.m. The call is free.

The List of Covered Drugs and/or pharmacy and provider networks may change from time to time throughout the year. We will send you a notice before we make a change that affects you.

Benefits may change on January 1 of each year.

 

H7419_6530 CMS Approved
Page modified on: 10/10/2019 5:00:45 PM