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Medication Therapy Management (MTM) Program

The Healthfirst Medication Therapy Management (MTM) program is an in-depth, one-on-one review of all your medications (prescription, over-the-counter, herbal, and nutritional).

The MTM program is not a benefit, but rather an extra service offered at no additional cost to eligible participants. The goal is to help you understand your medications and use them safely.

You’ll be contacted by mail and phone if you’re eligible to participate in this program.

Medicare Advantage Plans

To be eligible, you must have at least three of the following specific chronic diseases:

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic Heart Failure (CHF)
  • Dyslipidemia
  • End-Stage Renal Disease (ESRD)
  • Rheumatoid Arthritis

And –

  • Be on at least eight covered Part D chronic medications
  • Be likely to incur an annual Part D drug cost of $5,330 or greater

Or –

  • Are in a Drug Management Program to encourage safe use of medications, including those for pain management

MTM Services Include:

  • A phone consultation with a licensed pharmacist to complete a Comprehensive Medication Review (CMR). This will take about 30 to 60 minutes, and they’ll answer any questions you have. (A CMR is offered once each year, if you qualify.)
  • Medication Action Plan (MAP).
  • Medication recommendations may be sent to your provider from the MTM pharmacist, also known as Targeted Medication Review (TMR).
  • Personal medication list that lists all your medications.

For more information about your eligibility or to schedule an appointment for a medication review with one of our Clinical Pharmacists, call us at 1-844-450-5721 (TTY 311), Monday to Thursday, 9am–6:30pm, and Friday, 9am–5:30pm. Within 14 days of completing your medication review, you will receive a summary of what was discussed, including action items and a list of your medications, cost savings opportunities, and potential drug interactions.
The results may be sent to your doctor for their review.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.

Healthfirst complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-305-0408 (TTY 1-888-542-3821).


Last update September 26, 2024 @ 2:52 pm

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