WHA Care+

Medication Therapy Management Program (MTMP)

Medication Therapy Management (MTM) is a CMS program that MA-PD plans (like WHA Care+) must offer to their Medicare beneficiaries. Its purpose is to optimize therapeutic outcomes through improved medication for beneficiaries that meet the following criteria:

• A beneficiary must have at least 5 chronic conditions, with at least 2 of the following: Hypertension, High Cholesterol, Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease (COPD).
• A beneficiary must have claims for at least 6 different covered Medicare Part D medications. Both chronic and acute medications are considered in the evaluation process.
• A beneficiary must be likely to incur annual costs of at least $4,000 for all covered Medicare Part D drugs.

To be eligible for MTM services, beneficiaries must meet all three of these criteria.

Here's how the MTM Program works:

1. Medco, our prescription benefit manager, will identify Medicare members who meet all three of the criteria listed above as eligible for MTM services (based upon at least 12 months of continuous eligible pharmacy data).
2. Medco will mail a letter to all qualifying beneficiaries explaining the MTM Program and inviting them to call and speak with a pharmacist for counseling.
3. Those beneficiaries that accept the invitation for MTM services will receive assistance from Medco pharmacists who are specially trained in medication education services for patients. These education services will include:
   • Medication compliance
   • Drug education
   • Health and safety issues
   • Cost savings opportunities (where appropriate)

If you have any questions, please contact the WHA Care+ Member Services Department for additional information.

Note: The Medication Therapy Management Program is not considered a benefit.

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