What is an MTM?

A Medication Therapy Management Program, or an MTM, is a service offered to members of Medicare drug plans who meet specific criteria. Eligible patients with multiple medical conditions have the ability to enroll in these programs, which are funded by a patient’s Part D sponsor (drug plan). Here’s how they work: MTMs allow a patient to schedule a Comprehensive Medication Review (CMR) with their pharmacist to review their medication regimen. Patients receive an individualized action plan based off of their current medication list. This helps ensure that patients are on the right medications, getting the most benefit from their medications, and provide a deeper explanation as to why they are on each medication.

Who Qualifies?

To be a targeted beneficiary of an MTM for the year, enrollees are required to meet all of the following criteria:

  • Have a maximum of 2 or 3 chronic diseases from this list of nine core chronic conditions.
  • Are currently taking multiple Part D drugs, with eight Part D drugs being the maximum number of drugs a Part D plan sponsor can require
  • Are likely to incur annual costs for covered Part D drugs greater than or equal to the year’s specified MTM cost threshold. Find the current 2015 and forecasted 2016 threshold listed below

What does this mean for Pharmacies/The Future? Some pharmacies have reported mixed experiences with these programs. For example, MTM programs can be time consuming for a small community pharmacy, especially if they serve a large number of patients who require MTM services. However, MTM programs are pushing pharmacies to become key participants in the coordination of care for patients who had more clinic visits to many different providers, were prescribed more medicines, those more likely to miss appointments, and live in neighborhoods with lower income and educational levels - a crucial endeavor, as the number of these complex patients grows each year.

MTM programs are required to be approved by CMS each year. In 2016, CMS will attempt to address these issues and improve 2015’s MTM model by increasing the annual cost threshold for the program and include interns on the list of qualified individuals to hold MTM sessions with patients (and maybe save you all a little bit of time!)

For more information on the 2016 changes click here