Medication Therapy Management Program (MTMP) is a Centers for Medicare & Medicaid Services (CMS) mandated program required of all Medicare Part D sponsors. The purpose of a MTMP is to help Medicare Part D members:
- Understand their medications
- Optimize therapeutic outcomes through improved medication use
- Reduce the risk of adverse events, including drug-drug and drug-condition interactions
Blue Shield of California Promise Health Plan contracts with OutcomesMTMTM to provide MTMP services to eligible Medicare Part D members, including:
- A local community pharmacist network to provide interactive medication reviews and clinical interventions
- A Web-based application to document and report on pharmacist interventions and outcomes
- Clinical algorithms to identify medication-related issues from Part D claims and notify local pharmacists for consultations with members and their physicians
Medication Therapy Management Program services
Local community and consultant pharmacists who are part of the OutcomesMTMTM network receive notification of members who are eligible for the program. Additionally, pharmacists receive alerts for eligible members who may have medication-related issues or gaps in therapy. Pharmacists then work with members to resolve medication issues and provide recommendations to physicians to help optimize the medication regimen. Pharmacists will also provide MTMP services for members residing in long-term care facilities.
1. Annual Comprehensive Medication Review (CMR)
Pharmacists in the OutcomesMTMTM network will provide CMRs to eligible members. Pharmacists will meet one-on-one with members to review their complete medication history, including prescription, over-the-counter (OTC) and alternative medication therapies. The pharmacist will help resolve medication issues, identify ways to reduce out-of-pocket costs for prescriptions. They can also contact the prescriber with recommendations.
A written summary of the consultation, with relevant assessments and recommendations, will be provided to the member. Get a blank copy of the Personal Medication List. The member’s prescribing physician or primary care physician may be contacted by the pharmacist to coordinate care or recommend therapy changes when necessary.
Personal Medication List (blank), English (PDF, 110 KB)
2. Targeted Medication Review (TMR)
Pharmacists in the OutcomesMTMTM network will conduct TMR for eligible members, at least quarterly, throughout the year to identify potential gaps in medication therapy. Issues such as medication non-adherence, drug safety, and evidence-based treatments are addressed.
Upon identification of medication-related issues from CMR or TMR, the pharmacist can contact the member’s physician to discuss identified issues and provide recommendations for consideration. Changes to medication therapies are approved by the prescriber and discussed with the member.
Medication Therapy Management Program eligibility
Medicare Part D MTMP eligibility is based on CMS specifications. For 2022, Medicare Part D members are automatically enrolled in the program if they meet each of the following criteria (CMS minimum thresholds):
- Have been diagnosed with at least two of the following chronic medical conditions:
- Chronic heart failure (CHF)
- Respiratory disease - Chronic Obstructive Pulmonary Disease (COPD)
- Receive at least seven covered Part D maintenance medications per month
- Meet or exceed the CMS specified annual cost threshold ($4,696)
If you are eligible, you will receive a letter introducing you to the program with information on how to schedule an appointment with a pharmacist. You may also receive automated or direct calls from pharmacists to provide more information about MTMP. If you don’t want to or cannot participate, you may contact Blue Shield of California Promise Health Plan to opt out of the program.
There is no additional cost to you. This program is not a plan benefit and you may decide not to participate. However, we recommended that you take full advantage of this free service if you meet the eligibility requirements.
For more information about our Medication Therapy Management Program, call Blue Shield Promise Cal MediConnect Customer Care:
Phone: (855) 905-3825 [TTY: 711], 8 a.m. to 8 p.m., seven days a week.