Frequently Asked Questions
What is Medication Therapy Management (MTM)?
MTM is a provision of the Medicare Part D prescription drug plan that offers services designed to improve medication use and reduce adverse drug events. Services may include comprehensive medication reviews along with patient-specific medication and disease education.
Why should eligible individuals participate?
MTM services are designed to improve the Medicare beneficiary’s knowledge and understanding of their medications. It may be an opportunity for individuals to ask questions about their medications and diseases. The services can help each person more appropriately use their medications. MTM services may also help detect potential adverse drug events and patterns of over- or under-use of prescription drugs.
Will all Medicare Part D prescription drug plans offer this free service?
Yes, all drug plans are required to offer MTM services. However, each Medicare prescription drug plan determines which members are eligible and the types of services they provide. These programs will be provided at no additional cost to the eligible beneficiary.
Who will be asked to participate?
It is important to note that not everyone covered by the Medicare Part D prescription drug plan is eligible for MTM. Eligible individuals will be determined by the prescription drug plans with Medicare requiring that they target individuals who:- Have multiple chronic diseases, AND
- Have multiple medications covered by Part D, AND
- Are likely to spend at least $4,000 annually for all prescription drugs covered by Part D
In addition, each plan will determine the number of medications and the number and types of chronic diseases required to qualify an individual for their MTM services. This means that eligibility requirements will vary greatly from plan to plan.
How will the services be provided?
Each Medicare prescription drug plan selects their MTM delivery method. MTM programs will primarily use three means of communciation with beneficiaries. Eligible individuals may receive a phone call, written educational materials in the mail, face-to-face consultation with an approved MTM provider, or a combination of these.
Who will provide MTM services?
Drug plans can use any licensed health care professional including, but not limited to, pharmacists, nurses, and physicians as the provider of MTM services. Many plans will use internal staff at a central location to provide the services by phone or mail. A few plans will be contracting with community pharmacists to provide face-to-face MTM.
Are eligible Medicare beneficiaries obligated to participate in MTM services?
No. MTM services provided under the Medicare prescription drug plan are voluntary and there is no obligation to participate in the services. Eligible individuals will not be penalized if they do not participate and they will continue to receive their prescription drug benefits. However, MTM can provide significant value to participants, such as making sure they receive the most appropriate medications. All eligible beneficiaries are encouraged to consider participation in MTM services offered through Medicare’s prescription drug plan.