Medication Therapy Management

Why MTM?

• 85% of patients had one or more medication therapy problems identified by MTM services.¹
• 55% of patients who had not reached certain clinical goals when they enrolled in the MTM program improved during the course of MTM services.¹
• 93.3% of respondents agreed or strongly agreed that their overall health and well-being improved because of MTM services.¹

Frequently asked questions

What is the difference between a CMR and an annual TMR?

A comprehensive medication review (CMR) is a real-time, interactive medication review performed by a qualified healthcare professional to assess a patient’s medications (including prescriptions, over-the-counter medications, herbal therapies and dietary supplements) and is intended to aid in assessing medication therapy and optimizing patient outcomes.

A targeted medication review (TMR) is an ongoing monitoring process with outreach made to the patient and/or prescriber about a specific or potential medication-related problem, without a comprehensive assessment of the patient’s medications. TMRs may be performed to assess medication use, to monitor whether any unresolved issues need attention, to determine if new drug therapy problems have arisen or to assess if the beneficiary has experienced a transition in care.

Who is eligible?

• Humana-covered Medicare Advantage prescription drug plan (MAPD) and prescription drug plan (PDP) patients, including those in an Illinois Medicare-Medicaid Alignment Initiative (MMAI) dual plan, meeting all of the following criteria:
  • Have at least 3 of the following chronic diseases:
    • Diabetes
    • Chronic heart failure
    • Dyslipidemia
    • Asthma
    • Rheumatoid arthritis
  AND
  • Take a minimum of 8 chronic or maintenance (Part D) drugs
    AND
  • Have anticipated Part D drug costs of at least $4,696 in 2022

Contact your Provider Engagement representative in your market for a current list of your eligible patients.

Reference:

1. Ramalho de Oliveira, D., Brummel, A. R., and Miller, D. B. (2010). Medication therapy management: 10 years of experience in a large integrated health care system. Journal of Managed Care Pharmacy, 16(3), 185-195.

Consultation services

MTM services include comprehensive medication reviews (CMR) and targeted medication reviews (TMR). The CMR is a real-time review of the patient’s entire medication profile and is offered at least annually. Once enrolled in the MTM program, the patient or prescriber may be contacted about a TMR if an issue is identified with one of the patient’s medications. These TMRs address specific or potential medication-related problems and are used to assess medication use and issues needing attention.

Consultations may include:

• Medication adherence
• Medication safety
• Gaps in medication therapies
• Possible medication alternatives

Patient benefits

Eligible Medicare patients can have a face-to-face or telephone consultation with a qualified healthcare professional. The goal of the consultations is to help patients:

• Gain a better understanding of their medications
• Benefit from one-on-one time with a healthcare professional
• Receive recommendations for alternative treatments, if applicable
• Explore cost-saving opportunities

Patient eligibility

Patients who meet predetermined eligibility requirements may qualify for the MTM program. 

Eligibility requirements:

1. Have 3 or more of the following 5 conditions:
   • Chronic heart failure
   • Rheumatoid arthritis
   • Diabetes
   • Dyslipidemia
   • Asthma
   AND
2. Take 8 or more chronic maintenance (Part D) drugs
   AND
   Be likely to incur annual Part D medication costs of $4,696 in 2022

Once a Medicare or Medicaid patient becomes eligible for MTM, the patient will receive notification of his/her eligibility and an offer to schedule a consultation with a qualified healthcare professional.