Medication Therapy Management Program

About MTM

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 MTM program, you must meet one of the two following criteria:

• Be an At-Risk Beneficiary as defined by internal drug management program data and/or Medicare Advantage Prescription Drug System (MARx) data. or
• Meet ALL of the following criteria:
  • Have at least three of the following conditions: Osteoporosis, Chronic Heart Failure, Diabetes, Dyslipidemia, Hypertension, AND
  • Take at least 8 chronic/maintenance, covered Part D medications, AND
  • Are likely to have medication costs of covered Part D medications greater than $5,330 per year.

If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access it. If you qualify, we automatically enroll you in our MTM program. Participation is voluntary. You can opt out of the program at any time.

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

• Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, your caregiver, your pharmacist, and/or your provider if we detect a potential problem.
• Comprehensive medication review (CMR): at least once per year, we offer a free discussion and review of all your medications by a pharmacist or other health professional to help you use your medications safely. The CMR is provided to you confidentially via telephone. The CMR may also be provided in person or via telehealth. This review requires about 30 minutes of your time. Following the CMR, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary 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 how to use them the right way.

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, click below:

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