What is the MTM (medication therapy management program)?
One-on-one review with a pharmacist or other trained health care provider.
Medication Therapy Management (MTM), while not part of a prescription drug benefit, is a Medicare-designed program offered by Johns Shop Rite Pharmacy. By participating in the program we want to help you get the best results from all of the medications you’re taking. When you talk to a trained provider they can help you make sure your medications are working for you, may help you find lower-cost options, and answer any questions or concerns you may have about your medications.
How does the Medication Therapy Management (MTM) program work?
If you're like many Medicare members, you're taking multiple medicines prescribed by more than one doctor. You could also be taking medicines that, when combined, may:
How do I qualify for the program?
Your Medicare Insurance plan determines eligibility quarterly by looking at your medication claims information. Once you qualify, you remain in the program for the rest of the calendar year. You will have to re-qualify for the next calendar year.
2022 Criteria
You meet all 3 of the following:
You have three of the five following conditions:
Mental Health - Bipolar, Hypertension, Dyslipidemia, Bone Disease – Arthritis -Osteoporosis, COPD, AND
You are taking eight or more chronic/maintenance (Part D) drugs, AND
You’re likely to have annual Part D medication costs of $4,696 or more in 2022
OR
You qualified for the Drug Management Program because:
You’re taking an opioid medication prescribed by more than one provider and/or using more than one pharmacy, OR
You’ve had a drug-related hospital visit in the last 12 months and have been prescribed an opioid in the last 6 months
2023 Criteria
You meet all 3 of the following:
You have 3 of the 5 following chronic diseases:
Osteoarthritis, Hypertension, Asthma, Chronic heart failure, Schizophrenia AND
You are taking 8 or more chronic/maintenance (Part D) drugs, AND
You’re likely to have annual Part D medication costs of $4,935 or more in 2023
OR
You qualified for the Drug Management Program because:
You’re taking an opioid medication prescribed by more than 1 healthcare provider and/or using more than 1 pharmacy, OR
You’ve had a drug-related hospital visit in the last 12 months and have been prescribed an opioid in the last 6 months
How will my Insurance let me know I have qualified for the MTM program?
Once eligible, you will be auto-enrolled and will receive a notification within 60 days inviting you to participate in the program.
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Once enrolled, one of our MTM Pharmacists will perform your consultation over the phone.
You may also call us at 1-562-616-0056 (TTY: 711). Representatives are available Monday through Friday, 9 a.m. to 6 p.m. PST.
What you can expect when you complete a CMR
A trained pharmacist or health care provider will review your current medication program to:
Send you a summary of your consultation that includes the Personal Medication List, which is a list of all of the medications you're taking, and a To-Do list, which includes things that you talked about with the MTM provider
Each consultation takes about 15 minutes to complete but can range from about 10-30 minutes.