Many people who are enrolled in a Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage take more than one prescribed medication for multiple medical conditions. Such patients may benefit from a Medication Therapy Management (MTM) program, a tailored protocol of medications and advice to help them manage their medications so that they work as effectively as possible — and avoid potentially serious interactions. An MTM can also reveal other possible problems with a treatment plan along with possible cost saving options.
What Is Medication Therapy Management?
Medication Therapy Management consists of a specially tailored suite of services that are designed to help patients obtain maximum benefit from their prescription drugs. MTM plans may be provided as part of a Medicare Part D plan or a Medicare Advantage plan and are free of charge. Issues addressed by MTM plans include possible drug interactions, patients’ failure to properly take their medications or conditions that are inadequately addressed by medications or treatments. MTM includes personal consultations between patients, caregivers and healthcare providers and about all the medications and treatments they are taking, including over-the-counter (OTC) mediations or herbal supplements.
Who Qualifies for Medication Therapy Management?
Medication Therapy Management programs are designed for patients with complex medical conditions who are taking multiple prescription and over-the-counter medications. When administered with a Medicare Part D plan, MTM has a number of requirements for qualification. Patients meeting all the listed requirements are enrolled in an MTM program automatically, but may choose to opt out of using the services.
- Patients with two or more chronic health problems, including diabetes, Chronic Heart Failure (CHF), Rheumatoid Arthritis (RA), hypertension or high blood fat levels
- Patients taking eight or more prescribed medications covered by Medicare Part D
- Patients who spent $4,044 or more on Part D medications in 2019 and who will spend $4,255 or more on Part D medications in 2020
Components of Medication Therapy Management Plans
As a component of a Medicare Advantage Plan or a Medicare Part D plan, a Medication Therapy Management program provides individualized consultations for patients with physicians and other healthcare experts in the coordination of multiple medications. MTMs also provide guidance on maximizing the beneficial effects of related treatments such as physical therapy. Components that are commonly included in MTM plans are listed below.
- Comprehensive Medication Review (CMR):One on one consultation between the patient and healthcare professional to improve understanding of how prescription and over-the-counter medications work — and empower patients to manage their own medications and well being.
- Targeted Medication Review (TMR): Ongoing periodic monitoring intended to identify specific problems with prescription or OTC medications.
- Medication Action Plan (MAP):Specific set of actions developed from the CMR consultation detailing the patient’s responsibilities as well as the role of the healthcare provider.
- Personal Medication List (PML): A comprehensive list of all the medications presently used by a patient.
- Referral and Followup Recommendations: Additional resources provided or recommended for the patient.
Implementing a Medication Therapy Management Program
As part of a Medicare Advantage plan or Medicare Part D plan, an MTM provides patients with individualized guidance on the medications they take as well as their overall treatment plan. An MTM represents a comprehensive analysis of their prescription medications and an action plan for ensuring maximum benefit and minimizing potentially harmful drug interactions. An MTM can also disclose possible additional problems with a patient’s treatment plan, along with revealing areas for possible cost-saving measures