Medication Therapy Management Program (MTMP)
Health Net Medicare Advantage for California has programs that help members manage their Part D and other medications in special situations. For example, some members have several complex medical conditions at one time. These members may need to take many drugs at the same time, or they could have high drug costs. A team of pharmacists and doctors developed a program for us to help these members with their care. This program is called the Medication Therapy Management Program, or MTMP.
The MTMP can help make sure that our members are using the drugs that work best to treat their medical conditions, help us to identify possible medication errors, and help improve medication adherence. The program is not considered a benefit and is voluntary and free to eligible members.
Members who are eligible for the MTMP have:
- Three or more of the following chronic disease states:
- Chronic Obstructive Pulmonary Disease (COPD)
- End Stage Renal Disease (ESRD)
- Mental Health-Depression
- Eight or more chronic or maintenance Part D medications
- Most likely have higher drug costs (more than $3,967 each year)
If you meet the criteria for the MTMP, we will automatically enroll you in the program. An MTM pharmacist reviews your medication history and sends you a welcome letter indicating you have qualified for MTMP. The letter describes any potential medication related problems found during their review and invites you to call for a medication review with an MTM pharmacist. If you decide not to participate, please notify us and we will withdraw your participation in the program.
The pharmacist or pharmacy intern under the direct supervision of a pharmacist will provide the following MTMP services with a final goal of helping the member reach the best therapeutic results to fit their needs:
- An annual Comprehensive Medication Review (CMR) is conducted either by phone or a face-to-face meeting to provide a collection of all the member’s medication related information and address any medication concerns. The CMR will take approximately 45 minutes.
- A Personal Medication List (PML) to record all prescription and over-the-counter medications which can be updated as needed (click here for sample PML)
- A Medication Action Plan (MAP) made specific for the member after counseling to help them follow steps while taking medications to reach their health goals
- The PML and MAP are printed and either mailed or hand delivered within 14 calendar days of the Comprehensive Medication Review
- Quarterly Targeted Medication Reviews (TMR) which identify potential safety concerns, such as drugs which are not recommended for use in those over age 65, or any drug therapies that the member should be on, but are not, based on their conditions. If issues are identified, a letter is sent to the member and includes ways to help improve medication use. Additionally, a fax communication may be sent to the prescriber.
If the member is unable to participate, an authorized individual may participate on the member’s behalf. In addition, the pharmacist may work with other clinical team members if more services are needed in order to help the member reach their health goals.
To learn more or get additional information, please contact Member Services. Member Services is prepared to answer questions about the MTMP.
Our plan has programs that help you manage your Part D medications in special situations. For example, you may have several complex medical conditions. If so, you may need to take many prescription drugs to treat those conditions. You also could have high drug costs.
A team of pharmacists and doctors developed a program to help members like you with your healthcare. This is called the Medication Therapy Management Program, or MTMP. Our MTMP pharmacists help our members and their doctors choose the drugs that work best to treat their medical conditions. They also help identify possible errors and improve medication adherence.
The program is not a benefit. It’s an extra service that is voluntary and at no cost to eligible members who:
- Have three or more of these medical conditions:
- Chronic Obstructive Pulmonary Disease (COPD)
- End-Stage Renal Disease (ESRD)
- High cholesterol (hyperlipidemia)
- Take eight or more chronic or maintenance Part D drugs
- Spend more than $4,044 each year on drugs
If you meet the above criteria, we enroll you in our program automatically. From there, one of our MTMP pharmacists reviews your medication history and sends you a welcome letter. The letter describes any potential medication related problems found and invites you to call for a full review. If you don’t want to continue, just notify us. We will remove you from the program.
If you want to continue, one of our pharmacists or pharmacy interns, under the direct supervision of a pharmacist, will connect you with the following services. The goal is to help you reach the best results to fit your needs:
- Annual Comprehensive Medication Review (CMR). Conducted by phone or face-to-face, a CMR creates a collection of all of your medication-related information. The pharmacist will go over your medications and medical conditions. The CMR takes approximately 45 minutes and addresses any of your concerns.
- Personal Medication List (PML). A list of all your prescriptions and over-the-counter medications discussed during the review. The PML can be updated as needed. Sample PML (PDF)
- Medication Action Plan (MAP). One of our MTMP pharmacists creates your MAP. It helps you follow steps in taking medications to reach your health goals.
- We print your PML and MAP and either mail or hand-deliver them to you within 14 days of your CMR.
- Quarterly Targeted Medication Reviews (TMR). TMRs identify potential safety concerns for you. They include drugs that people over age 65 should generally not take, or drug therapies that you should be on based on your conditions but aren’t. If our MTMP pharmacists find issues, we send you a letter with ways to help improve your medication use. We may also fax any issues to your doctor.
If you want to participate in our MTMP but are unable to, you can authorize someone on your behalf. Our MTMP pharmacist who helps you may work with other team members if you need more services to help you reach your health goals.
If you have questions about the MTMP, contact Member Services.