MTM is a service offered by Jefferson Health Plans at no additional cost to you! The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. Jefferson Health Plans partners with Outcomes to provide MTM services.

To qualify for our Medication Therapy Management (MTM) program, you must meet one of the two following criteria:

1. Be an at-risk beneficiary as defined by internal drug management program data and/or Medicare Advantage Prescription Drug System (MARx) data, OR
2. Meet ALL of the following criteria:

   1. Have at least three of the following conditions:

      • Alzheimer's Disease
      • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
      • Chronic congestive heart failure (CHF)
      • Diabetes
      • Dyslipidemia
      • End-stage renal disease (ESRD)
      • Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
      • Hypertension
      • Mental health condition (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
      • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)

      AND

   2. Take at least 8 Part D maintenance drugs, AND
   3. Have incurred one-fourth of the specified annual cost threshold ($1,623) in the previous three months.

As part of our MTM program, you are eligible for medication reviews.

Targeted Medication Review:

At least quarterly, we will review your prescription medication claims and contact you and your provider to resolve potential drug therapy problems. This review takes about 15 minutes.

Comprehensive Medication Review (CMR):

At least once per year, we offer a free, interactive, person-to-person consultation with an MTM provider that may be delivered to you face-to-face, via phone, or telehealth. A CMR usually takes about 30 minutes. During the CMR, the MTM provider reviews your medications, including prescription, non-prescription, samples, and herbals/supplements.* At the conclusion of the CMR, an individualized, written summary of the interactive consultation is provided to you, your caregiver, or other authorized representative (if applicable), and any drug therapy problems identified are resolved with you and the provider, as appropriate.

The written summary from the CMR includes a:

• Recommended To-Do List (TDL): The TDL has steps you should take to help you get the best results from your medications.
• Personal Medication List (PML): The PML will help you keep track of your medications and explain how to use them correctly.

To obtain a blank copy of the PML that can help you and your health care providers keep track of the medications you are taking, choose your preferred language below:

• English
• Spanish

*A CMR will be performed with the beneficiary’s provider, caregiver, or other authorized representative only when the beneficiary is cognitively impaired.