Medication Therapy Management
Clarion Health offers a Medication Therapy Management (MTM) program at no extra charge to you. The program is not a benefit. It is a free service offered to those who are eligible and qualify for the program. Once enrolled in the program, there are no changes to your copays or other benefits.
The MTM Program helps you get the most benefit from your medications by:
- Preventing or reducing side effects
- Making you more aware of your condition and the importance of your medication
- Managing what you spend on drugs
Who qualifies for the MTM Program?
To qualify for the MTM program, you must have:
- Three or more chronic conditions consisting of
- Chronic heart failure
- High cholesterol: Dyslipidemia
- High blood pressure: Hypertension
- Respiratory disease: Chronic obstructive pulmonary disease
- Eight or more Part D maintenance medications (drugs prescribed for long-term conditions) for chronic disease; and,
- $4,255 in yearly prescription drug costs paid by you and the plan.
If you qualify, you’ll get a welcome letter mailed to your home. Medicare requires MTM programs to automatically enroll members who qualify throughout the calendar year, but participation is voluntary and you can choose not to participate any time. The welcome letter provides instructions on how to withdraw from the program.
What services are included in the MTM Program?
The MTM Program provides you with a:
- Comprehensive Medication Review (CMR), and
- Targeted Medication Review (TMR)
Comprehensive Medication Review (CMR)
A CMR is a one-on-one consultation to review all of your medications and medical conditions and answer any questions that you may have.
The review will take place with a pharmacist over the phone.
The pharmacist will offer ways to manage your conditions with the drugs you take. If needed, the pharmacist may contact your doctor.
A CMR takes about 30 minutes and is usually offered once each year to qualifying members.
At the end of your consultation, you will receive a cover letter, the medication action plan, and a personal medication list within two weeks of speaking with the pharmacist. The action plan has steps you should take to help you get the best results from your medications. The medication list will help you keep track of your medications and how to use them the right way.
Targeted Medication Review (TMR)
You may also have Targeted Medication Reviews (TMRs) performed for you. TMRs are identified on at least a quarterly basis (every three months) to address potential medication-related issues. When these issues are identified, the doctor prescribing the medication may be contacted about the potential issue and provided suggested interventions. As always, your prescribing doctor will decide whether or not to consider our suggestions. You may also receive information about a TMR directly, when needed.
How can I get more information about the Medication Therapy Management Program (MTM Program)?
If you would like information about the MTM program, please contact:
Member Services department at 1-844-824-8771 (TTY/TDD users, please call 711)
Seven days a week, 8 am to 8 pm Oct 1 – Mar 31
Monday – Friday 8am to 8pm Apr 1 – Sept 30
MTM Pharmacy Services can be reached at 866.823.1633 9 a.m.- 5 p.m. Eastern, Monday through Friday. TTY users dial 711.