Medication Therapy Management Program

According to CMS, to be eligible for participation in a Medication Therapy Management (MTM) program, a candidate must meet one of the following two groups:  

1. Meet all of the following criteria:  
   1. Have multiple chronic diseases (up to at least three): Alzheimer’s disease, Bone disease-arthritis (including osteoporosis osteoarthritis, and rheumatoid arthritis), chronic CHF, Diabetes, Dyslipidemia, End-stage renal disease (ESRD), Human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), Hypertension, Mental health (including depression, schizophrenia, bipolar disorder, and chronic/disabling mental health conditions), and Respiratory disease (including asthma, COPD, and chronic lung disorders); AND 
   2. Taking multiple Part D medication (up to eight medications as a minimum); AND 
   3. Likely to incur annual costs for covered Part D medications greater than or equal to a specified MTM cost threshold 
2. An at-risk beneficiary with an active coverage limitation under a drug management program (DMP). 

Prime Therapeutics, the Medicare Advantage Pharmacy Benefit Manager, is committed to optimizing therapeutic outcomes by improving the use of drugs to avoid adverse drug events. Prime does this through both an internal MTM department and external MTM vendors that provide annual Comprehensive Medication Review (CMR) services for MTM-enrolled Covered Persons. Prime also provides quarterly, criteria-based Targeted Medication Review (TMR) services to MTM-enrolled Covered Persons.