2021 Medication Therapy Management Program2020-09-23T09:36:26-04:00

2021 Medication Therapy Management Program

If you’re in a Medicare drug plan and have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Prominence Health Plan at no additional cost to you! The MTM program is required by the Centers for Medicare & Medicaid Services (CMS) and is not considered a benefit. This program helps you and your doctor make sure your medications are working. It also helps us identify and alleviate possible medication problems.

Florida and Nevada Program Criteria

To qualify for Prominence Health Plan’s MTM program in Florida and Nevada, you must meet all the following criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems.

  1. Have at least two of the following conditions or diseases:
    • Bone Disease — Arthritis —Rheumatoid Arthritis
    • Chronic Heart Failure (CHF)
    • End-Stage Renal Disease (ESRD)
    • Mental Health — Bipolar Disorder
    • Mental Health — Depression
    • Respiratory Disease — Asthma
    • Respiratory Disease — Chronic Obstructive Pulmonary Disease (COPD)
    • Autoimmune Disorders
  2. Take at least six covered Part D medications
  3. Incurred one-fourth of specified annual cost threshold ($4,376) in previous three months

If you meet all the criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to enroll. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

Texas Program Criteria

To qualify for Prominence Health Plan’s MTM program in Texas, you must meet all the following criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems.

  1. Have at least two of the following conditions or diseases:
    • Bone Disease — Arthritis —Rheumatoid Arthritis
    • Chronic Heart Failure (CHF)
    • End-Stage Renal Disease (ESRD)
    • Mental Health — Bipolar Disorder
    • Mental Health — Depression
    • Respiratory Disease — Asthma
    • Respiratory Disease — Chronic Obstructive Pulmonary Disease (COPD)
    • Autoimmune Disorders
  2. Take at least four covered Part D medications
  3. Incurred one-fourth of specified annual cost threshold ($4,255) in previous three months

If you meet all the criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to enroll. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

Clinical Review of Medications

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

  • Targeted medication review (TMR) — At least quarterly, we will review all your prescription medications and contact you and/or your doctor by phone or mail if we detect a potential problem.
  • Comprehensive medication review (CMR)  At least once a 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. This review is provided to you confidentially via telephone by SinfoníaRx. The primary method of CMR completion will be via telephone, however, CMRs may also be completed via telehealth or face-to-face. These services are provided on behalf of Prominence Health Plan. This review requires about 30 minutes of your time. Following the review, you will receive a written summary of the call, which you can take with you when you talk with your doctors. This summary includes a:
    • Medication Action Plan (MAP), which has steps you should take to help you get the best results from your medications
    • Personal Medication List (PML), which will help you keep track of your medications and how to use them the right way

Download a blank copy of the Personal Medication List

If you take many medications for more than one chronic health condition, contact your drug plan to see if you are eligible for MTM. For more information, please contact customer service at 844-587-7389.

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Last update 9/26/2020