If you're in a Medicare drug plan and you have complex health needs, you may be able to take part in in an MTM program. MTM is a service offered by Kern Family Health Care Medicare (HMO D-SNP) at no added cost to you! The MTM program is required by the Centers for Medicare and Medicaid Services (CMS), the government agency that runs Medicare and Medicaid. It is not considered a benefit. This program helps you and your doctor make sure that your drugs are working. It also helps us find and reduce possible drug problems.
To take part in this program, you must meet certain rules set forth in part by CMS. These rules are used to find people who have multiple chronic health problems and are at risk for drug-related problems. If you meet these rules, we will send you a letter inviting you to join the program. It will also have information about the program and how to use it. Your enrollment in MTM is voluntary. It does not change your Medicare coverage for drugs covered under Medicare.
To qualify for the MTM program, you must meet one of the two rules below:
- Be an At-Risk Beneficiary or
- Meet ALL of the following:
- Have at least 3 of the health problems listed below:
- Alzheimer’s Disease
- Bone Disease-Arthritis
- Osteoporosis
- Osteoarthritis
- Rheumatoid Arthritis
- Chronic Heart Failure (CHF)
- Diabetes
- Dyslipidemia (abnormal levels of fats in your blood)
- End-Stage Renal Disease (ESRD)
- Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
- Hypertension (High Blood Pressure)
- Mental Health (Depression, Schizophrenia, Bipolar disorder, and other chronic/disabling mental health problems)
- Respiratory Disease (Asthma, Chronic Obstructive Pulmonary Disease (COPD), and other chronic lung problems), AND
- Take at least 8 covered Part D drugs, AND
- Are likely to have drug costs of covered Part D drugs greater than $1,276 per year.
- Have at least 3 of the health problems listed below:
To help lower the risk of possible drug problems, the MTM program offers two types of clinical review of your drugs:
- Targeted Medication Review: at least every 3 months, we will review all your prescription drugs. We will reach out to you, your caregiver, and/or your doctor if we find a potential problem.
- Comprehensive Medication Review (CMR): at least once per year, we offer a free discussion and review of all your drugs by a pharmacist to help you use your drugs safely. This CMR is provided to you confidentially by phone by Aspen RxHealth. These services are provided for Kern Family Health Care Medicare (HMO D-SNP). This review will take about 30 minutes of your time. After the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:
- o Recommended To-Do List (TDL): The list has steps you should take to help you get the best results from your drugs.
- o Personal Medication List (PML): The drug list will help you keep track of your drugs and how to use them the right way.
We have included a blank copy of the PML that can help you and your health care providers keep track of the drugs you are taking.
List of Medications Lista de Medicamentos
If you take many drugs for more than one chronic health condition, contact your drug plan to see if you’re eligible for MTM. For more information, please call Member Services at 866-661-3767.
To find out more about MTM through our partner, Aspen RxHealth, please visit their website: https://aspenrxhealth.com/