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Medication Therapy Management (MTM) Program


What is the Medication Therapy Management (MTM) Program?

It is a program for Medicare Part D members to learn more about their medicines. This helps ensure safe use of medications.

Who is eligible?

You must meet ALL of the following criteria to be eligible for MTM services:

  • Have Medicare Part D coverage with Scott and White Health Plan
  • Have at least 3 of the chronic diseases listed below.
    • Alzheimer's Disease
    • Osteoporosis
    • Rheumatoid Arthritis
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia (high cholesterol)
    • Hypertension (high blood pressure)
    • Bipolar Disorder
    • Depression
    • Schizophrenia
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
  • Take at least 8 chronic / maintenance medications covered by your Medicare Part D plan.
  • Be likely to spend a certain amount on Part D covered drugs each year. For 2021, you must be likely to spend $4,376 ($4,696 in 2022).

Is there a fee for MTM services?

There is no fee for MTM services if you meet the above criteria.

Who provides the MTM services?

A company called Clinical Support Services, Inc. (CSS) provides the MTM services.  CSS has specially trained MTM providers

What types of MTM services are offered?

1. A Comprehensive Medication Review (CMR) once a year

  • A CMR can help you learn more about your medications. This includes over the counter (OTC) products and supplements.
  • During a CMR, a qualified MTM provider talks with you and reviews your medications. The MTM provider works with you to create a plan to address any medication problems.
  • After a CMR, you will be provided a written summary. That summary will be delivered by mail and will include the following materials:
    • Cover Letter (CL)
    • Medication Action Plan (MAP)
    • Personal Medication List (PML)
  • Where are CMR visits conducted?
    • Over the phone
  • How long is a CMR visit?
    • The time required to conduct a CMR depends on many factors. Typically, a CMR takes less than 30 minutes.

2. Targeted Medication Reviews (TMR) every 3 months

  • These reviews help to ensure safe use of medications. These reviews may focus on one drug or many drugs.
  • Your medications will be reviewed to see if you may be taking the targeted medication(s). If a medication problem is found during the review, your doctor will be notified. Often, this is in the form of a letter.

How do patients enroll?

MTM services are not a benefit for all Part D members, but are offered for free to members who qualify for the plan’s MTM program.

Once you are eligible for the MTM program, you are automatically enrolled.

You will be sent a welcome letter inviting you to take part in a CMR. The letter will describe the MTM program and describe how to schedule a CMR. You may also get a phone call inviting you to schedule a CMR.

You may disenroll from the MTM program at any time. You may also refuse certain services and still stay enrolled in the MTM program. For example, you can refuse to schedule a CMR but stay in the MTM program. In this case, your medications would still be screened during the TMRs.

For more information

To learn more about the MTM program or to see if you are eligible for the program, call Clinical Support Services, Inc. (CSS) at 1-855-428-5738 8 am — 5 pm CST.

If you do not have questions about the MTM program but have questions regarding your Medicare benefit, contact SWHP at 1-866-334-3141 7 am — 8 pm CST 7 days a week. TTY/TDD users should call 711.

Personal Medication List

It is important to keep a list of your medications. Feel free to print and use the medication list templates below. If you take OTC medications or supplements, include these on your list too. Be sure to share your medication list with each of your healthcare providers.