Medication Therapy Management (MTM) Program | Healthfirst

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 get the most from your medications.

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:

  • Bone Disease, Arthritis, Osteoarthritis
  • Chronic Heart Failure (CHF)
  • Diabetes
  • Dyslipidemia
  • Hypertension

And –

  • Be on at least eight covered Part D medications
  • Be likely to incur an annual Part D drug cost of:
    • $4,255 for 2020 plans

MTM Services Include:

  • Phone consultation with a licensed pharmacist to complete a Comprehensive Medication Review (CMR). This will take about 30 to 60 minutes, and the pharmacist will answer any questions you have. (A CMR is usually 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.

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 Health Plan, Inc. offers HMO plans that contract with the Federal Government. Healthfirst Medicare Plan has a contract with New York State Medicaid for Healthfirst CompleteCare (HMO SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the Healthfirst Life Improvement Plan (HMO SNP). Enrollment in Healthfirst Medicare Plan depends on contract renewal.

The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by Healthfirst Health Plan, Inc. ICAN may be reached toll-free at 1-844-614-8800 or online at (TTY users call 711, then follow the prompts to dial 844-614-8800).

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

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