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Understanding Medicare Part D’s Medication Therapy Management Program

Written by Evens Stevenson

For those who are enrolled in a Medicare Part D prescription drug plan and who take medication for different medical conditions, it may be possible for you to obtain a service that is offered by Medicare – at no additional charge – via a Medication Therapy Management, or MTM, program.

Regardless of where you Part D plan is through, they are required by federal law to offer one of these MTM programs. They are voluntary, if you don’t want to participate, you aren’t required, but we would highly suggest that you take advantage of the program.

This program, referred to as the Medicare Part D Medication Therapy Management (MTM) program, can assist both you and your physician to ensure that all of your prescriptions are working to improve your overall health.

Currently, MTM programs are required to provide three different things to Part D enrollees. The first is that they have to provide interventiomedicare medication therapy managementn for beneficiaries and prescribers. Secondly, the have to give a yearly review for the enrollee which will include a face-to-face meeting or through telephone. We will discuss what will happen in this meeting later in the post. Every quarter, they have to provide a comprehensive review and any follow up meetings or calls if necessary.

When enrolled in the MTM program, a pharmacist (or other similar health care professional) will provide you with an overall review of all of your prescriptions. He or she will discuss with you information regarding how to obtain the most benefit from the medications that you take.

They will also talk with you about any concerns that you may have, such as drug reactions or side effects, as well as the cost of your medications. Likewise, they can provide you with advice on how and when to best take your prescription medications.

Following your talk with the pharmacist, you will receive a written summary of your discussion. This way, you will have a record of the questions that you asked, as well as the answers that were provided. The summary will also provide you with a plan of action that will recommend what you should do in order to make the best use of your prescription medications.

On this summary, there will also be space available for you to make notes, as well as for you to write down any follow up questions or concerns to ask the pharmacist or health care professional at a later time.

In addition, you will also receive a personalized medication list that includes all of the medications that you are currently taking, as well as a description of why you are taking them. This information is helpful to have with you whenever you talk to any of your health care providers.

How to Qualify

In order to qualify for the Medicare Part D Medication Therapy Management (MTM) program, you will need to meet all of the following conditions:

  • You will need to have more than just one chronic health condition
  • You will need to have more than just one medication that you are taking
  • The medications that you are currently taking must have a combined total cost of more than $3,017 per year. (This dollar amount is based upon your out-of-pocket costs, as well as the amount that your Medicare Part D prescription drug plan pays each year. This amount is also subject to change each year. Your Medicare Part D plan can help you in determining how much you have paid out, and whether or not you have reached this dollar amount limit.)

The Medicare Part D Medication Therapy Management program can help Medicare enrollees to keep track of the prescription medications that they are taking, which can lead to much better health care monitoring – and therefore, better health, overall.

Enrolling

If you qualify for MTM, you’ll automatically be enrolled in the program. Originally when the government mandated these programs, enrollees were required to specifically enroll into them, but since then they have been adapted to an “opt-out” style, which means that if you meet all of the criteria, you’re in the program. The Part D company will send you a notice in the mail within the first couple of months that you enter into the Part D plan, or once you meet the criteria.

The older that we get, the more prescriptions that most people start taking, which can cause problems for both your health and your budgets. The summary that the professional provides can help you in several different ways. The first is, it makes it easy to keep track of all your medications and understand what each prescription is treating. The more medications that you take, the more difficult it is to keep them all straight, which is why these reviews are vital.

These reviews also make it easier for your physicians when you go for check-ups. It’s vital that you doctor knows every treatment that you’re taking, forgetting one of them, or having any type of miscommunication could have dire consequences or lead to serious side effects. These reviews gives you simple documents that you can take with you to your doctor’s appointments.

If you have any questions about Part D plans or the MTM program, please feel free to contact one of our agents. We will be happy to answer those questions and ensure that you’re getting the coverage that you deserve. Our agents are dedicated to helping you make informed decisions about your health care choices.

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