What is a Medication Therapy Management Program (MTM)?

The MTM program is a Centers for Medicare and Medicaid Services (CMS) requirement for Medicare drug plans. If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in the MTM program. The goal of the MTM program is to have a health professional review all of the medications you take to identify any gaps in your medical care. The review also makes sure you are taking all of your medications in the most effective way to treat your medical conditions.

How much does MTM cost?

MTM is a service offered by Denver Health Medical Plan, Inc. (DHMP) at no additional cost to you! Participation in the MTM program is fully covered by DHMP for eligible Medicare members.

Which Medicare members are eligible for MTM?

To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems.

To qualify for the DHMP MTM program, you must meet all the criteria from at least one of the following two groups:

Group A

• Be a DHMP member with current Medicare Part D coverage
• Have at least Two of the following conditions or diseases:
  • Chronic Heart Failure (CHF)
  • Diabetes
  • Dyslipidemia
  • Hypertension
  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
• Take at least Seven covered Part D medications
• Are likely to have medication costs of covered Part D medications equal to or greater than $4,696 per year.

Group B

• Be a DHMP member with current Medicare Part D coverage
• Be an at-risk beneficiary (ARB) with an active coverage limitation under DHMP's Drug Management Policy (DMP)

Why should I participate in MTM?

This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems. If you meet criteria, DHMP will send you a letter with information about the program and invite you to participate. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

What is a Targeted Medication Review (TMR)?

A TMR is a type of clinical review performed at least quarterly. For a TMR, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor if we detect a potential problem.

What is a Comprehensive Medication Review (CMR)?

A CMR is a type of clinical review performed at least once a year. A CMR is a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely.

This review, or CMR, is provided to you confidentially in person or by telephone. The trained health professional conducting the review will check for drug safety problems and ways to save you money. This is also an opportunity to discuss any questions or concerns you have about your medicines.

This review typically requires 10-30 minutes of your time. You will get a written summary of the medication review, which you can take with you when you talk with your doctors. This summary includes:

• Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications.
• Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

You can download a blank copy of the Personal Medication List to help you and your health care providers keep track of the medications you are taking.

How can you get additional information or answers to questions?

If you think you might be eligible to participate in the MTM program, or you want more information, please contact Health Plan Services at 1-877-956-2111. TTY users call 711. Our hours of operation are 8 a.m. – 8 p.m. seven days a week.