What is MEDICATION THERAPY MANAGEMENT (MTM)

Purpose:

** To optimize therapeutic outcomes for individual patients.
** Optimize drug therapies.
** Improve medication use.
** Reduce risk of adverse events and drug interactions.
** Increase patient adherence and compliance with prescription drugs.
** Identify interventions that provide improved care to members.
** Interventions should result in health benefits for the Members and cost effective for the Members  and CarePlus.

Medicare Required Criteria for MTM Eligibility:
** Beneficiary must have multiple chronic diseases.
** Beneficiary must have filled multiple covered Part D drugs.
** Beneficiary must be likely to incur annual cost of more than $3,000 all covered Part D drugs.

CarePlus MTM Eligibility:
** Member must be diagnosed with 3 or more core chronic disease conditions.
** Members with 8 or more unique Part D Medications.
** Have anticipated cost of medications above a predetermined dollar amount ($3,000 per year for 2012) (Ex. If a Member spends more than $1,000 in a quarter, it can be assumed they will spend  at least $3,000 in a year.)

Examples of Core Chronic Conditions:
** Chronic Heart Failure   
** Diabetics Mellitus
** Dyslipidemia 
** Hypertension

CarePlus MTM Program Design:
The  CarePlus  MTM  will  notify  the  beneficiary  of  the  Comprehensive  Medication  Review  (CMR) opportunity through MTM messaging in the Smart SummaryRx statements once determined eligible for  the  MTM  program.  The  phone  number  to  the  Member  Services  call  center  will  be  provided  so  the  member can schedule their CMR.

MTM  consultations  will  allow  a  beneficiary  to  speak  with  a  clinical  advisor  (Pharmacist,  Registered Nurse) about their CMR and / or any identified drug related problems.  The clinical advisor  will then  work through the targeted interventions by consulting with beneficiaries and serving as their advocates in contacting prescribers, as necessary, to resolve drug therapy problems.

CarePlus  will  perform  targeted  medication  reviews  at  least  quarterly  to  assess  medication  use  and determine if a follow up intervention is warranted for the beneficiary and / or prescriber. CarePlus will reach out to the beneficiary and / or prescriber via one of the following ways: Telephonic, Face to face, Mail or Fax.

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