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The Medication Management Therapy (MTM) Program

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Learn if you are eligible for the Medication Management Therapy (MTM) Program.

Can the Medication Management Therapy (MTM) Program help you with your medications?

If you receive your Medicare Part D drug coverage through Tufts Health Plan Medicare Preferred, you may be eligible for a Medication Therapy Management (MTM) program.

What is the MTM program?

This program was created to help us provide better care for our members. We have partnered with Clinical Support Services, Inc. (CSS) to provide this important service.  Specially trained qualified providers such as pharmacists and nurses will work with you and your doctor to make sure that your medications are appropriate, safe, and effective. We will also look for ways to save you money while optimizing your therapy/treatment. Our MTM team will review your medications for any potential issues and notify your provider if any are found. This program is not considered a benefit and is a free service for eligible beneficiaries. Participation in the program is always voluntary, and you may choose not to participate or disenroll at any time.

Who is it for?

Enrollment in this program is automatic if you meet specific criteria based upon:

  • The number of certain chronic conditions you may have
  • The number of covered Part D medications you may take
  • The estimated annual cost for your covered Part D medications

MTM Program Criteria

2018 MTM Program Criteria

As a member of Tufts Health Plan Medicare Preferred, you will be automatically enrolled in the Medication Therapy Management (MTM) program if you meet the following criteria:

  1. You have at least two (2) of the following chronic conditions:

  • Diabetes Mellitus

  • Chronic Obstructive Pulmonary Disease (COPD)

  • High Blood Pressure (Hypertension)

  • High Cholesterol (Dyslipidemia)

  • Chronic Heart Failure (CHF)

  • Asthma

  1. You have claims for four or more different covered Part D medications

  2. You have at least $3,967 in estimated annual drug costs for covered Part D medications

If you are eligible for the MTM program, you will receive a Welcome letter from our MTM Partner, Clinical Support Services, Inc. (CSS).  Within a few weeks of receiving the letter, you will receive a call from CSS to set up an appointment to speak to a clinical staff member and to complete the Comprehensive Medication Review (CMR). We encourage you to take full advantage of this service.

What is a Comprehensive Medication Review?

The Comprehensive Medication Review or “CMR” is done over the phone by a pharmacist or other qualified provider. Your medication history (prescription and over-the-counter), lifestyle, and medical history will be reviewed. Based on this information, the pharmacist may offer recommendations or suggestions related to medication therapy. Then, a Medication Action Plan (MAP) summarizing any concerns and a Personal Medication List (PML) is sent to you by mail within 14 days. This information, along with any recommendations, is also sent to your physician. A CMR for all eligible members is done at least once a year and should take between 15-20 minutes.

In addition to the CMR, Targeted Medication Reviews (TMR) are conducted four times a year. During a TMR, the Pharmacist will assess your medication use and monitor for any new potential drug therapy issues. Any recommendations that are identified, will be sent to your Physician.

Tufts Health Plan Medicare Preferred Members: 

Click here to print a blank copy of the Personal Medication List (PML) to keep for your records and share with your Provider.  You may also contact our Customer Relations Department to request a copy. 

Other Helpful Information

2018 HMO Prime Rx Plus Premium Changes for Low Income Subsidy

2018 HMO Prime Rx Premium Changes for Low Income Subsidy

2018 HMO Value Rx Premium Changes for Low Income Subsidy

2018 HMO Basic Rx Premium Changes for Low Income Subsidy

2018 HMO Saver Rx Premium Changes for Low Income Subsidy

For More Information

For additional information regarding Tufts Health Plan Medicare Preferred’s MTM Program, please contact our Customer Relations department. HMO  members should call 1-800-701-9000 (TTY: 711). Senior Care Options members should call 1-855-670-5927 (TTY: 711). Representatives are available Monday – Friday, 8:00 a.m. – 8:00 p.m. (Representatives are available 7 days a week, 8:00 a.m. – 8:00 p.m. from October 1 – February 14.) After hours and on holidays, please leave a message and a representative will return your call the next business day. 

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