Medication Therapy Management Program (MTM program)
The Piedmont Medicare Advantage MTM program helps you get the greatest health benefit from your medications by:
- Preventing or reducing drug-related risks
- Increasing your awareness
- Supporting good habits
Who qualifies for the MTM program?
We will automatically enroll you in the Piedmont Medicare Advantage MTM program at no cost to you if all three conditions apply:
- You take eight or more Medicare Part D covered maintenance drugs, and
- You have three or more of these long-term health conditions:
- Chronic obstructive pulmonary disease
- Chronic Heart Failure
- <HIV (2017 only)>
- Cardiovascular disorders such as high blood pressure, high cholesterol, or coronary artery disease
3. <For 2017, you reach $3,919 in yearly prescription costs paid by you and the plan.>
For 2018, you reach $3,967 in yearly prescription drug costs paid by you and the plan.
Your participation is voluntary, and does not affect your coverage. This program is no cost to you and is open only to those who are invited to participate. The MTM program is not a benefit for all members.
What services are included in the MTM program?
The MTM Program provides you with a:
- Comprehensive Medication Review (CMR), and a
- Targeted Medication Review (TMR)
Comprehensive Medication Review (CMR).
A CMR is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:
- Prescription drugs
- Over-the-counter (OTC) medicines
- Herbal therapies
- Dietary supplements and vitamins
The pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the pharmacist may contact your prescribing doctor. A CMR review takes about 30 minutes and is usually offered once each year—if you qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List of the medications you discussed during your CMR.
You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.
Here is a blank copy of the Personal Medication List CLICK HERE for tracking your prescriptions.
Targeted Medication Review (TMR).
With a TMR, we mail, fax or call your doctor with suggestions about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them. We may also contact you, by mail or phone, with suggestions about your medications.
How will I know if I qualify for the MTM program?
If you qualify, we will mail you a letter letting you know that you qualify for the MTM program. Also, you may receive a call, inviting you to participate in this one-on-one medication review.
Who will contact me about the review?
You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You will be given the option to choose an in-person review or a phone review.
You may be contacted by a call center pharmacist to provide your review, and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.
Why is a review with a pharmacist important?
Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:
- Discuss how your prescription drugs and OTC medications may affect each other.
- Identify any prescription drugs and OTC medications that may cause side effects, and offer suggestions to help.
- Help you get the most benefit from all of your prescription drugs and OTC medications.
- Review opportunities to help you reduce your prescription drug costs.
How do I benefit from talking with a pharmacist?
- Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely.
- The pharmacy can look for ways to help you save money on your out-of-pocket prescription drug costs.
- You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with your doctors and health care providers.
How can I get more information about the MTM program?
Please contact us if you would like additional information about our MTM program, or if you do not want to participate after being enrolled in the program. CVS Caremark Customer Care's toll free number is 1-866-494-9927, 24 hours a day, 7 days a week. TTY users call 7-1-1.
Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
H1659_Web2018 Approved 10112017
Last updated 10/16/2017