Medication Therapy Management Programs

December 25, 2016

Some Medicare health plans are not included in Part C (Medicare Advantage Plans), but provide coverage as separate independent plans just like Part C plans.  Each of these plans has special rules and exceptions.  Some provide both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, while others only provide Part B.  Some may also provide Medicare Part D (Prescription Drug Coverage).

One of these plans is the Medication Therapy Management (MTM) program.  This plan facilitates management of medications if you are enrolled in a Medicare drug plan.  It offers:

  • A list of your medications and the reasons why you take them,
  • An action plan to help you make the best use of your medications, and
  • A summary of your medication review with your doctor or pharmacist.

In order to get MTM services free of cost you must make sure the following conditions apply:

  • You’re in a Medicare drug plan, and
  • You take medications for different medical conditions.

You will still have to contact your drug plan to find out if you are eligible.

The MTM program helps you and your doctor ascertain that all your medications are helping you with your health needs and/or health improvement.  When enrolled with MTM, your pharmacist or other health professional will give you a comprehensive review of your medication requirements and discuss them with you to help you achieve maximum benefits from the prescribed drugs.  The health professionals will also discuss concerns like medication costs and drug reactions; how to take your medication for best results; and questions/concerns about prescription and/or over-the-counter medication.

The discussion summary will then be provided to you in a written form, along with an action plan that you will need to follow for best medication outcomes.  The summary will also have space for comments and follow-up questions or concerns.

You will also get a personal medication list after this discussion, indicating which medicines you are taking and why.

You should bring both the discussion summary and medication list to your Medicare wellness visit, so you should schedule your MTM review before your wellness visit.  You should have the discussion summary and medication list with you at all times when talking about your condition and/or plan with any doctors, pharmacists, or other health care providers that are part of your plan.  You should also have these documents with you when you visit a hospital or an emergency room.

This is not a complete description of Medication Therapy Management ProgramsFor more information, speak with Medicare customer support at 1-800-MEDICARE, or contact Medigap, Inc. at 1-855-214-4404.

Source: Medicare

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