If you are in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by your Banner Medicare Advantage Plan 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. This program helps you and your provider make sure your medications are working. It also helps us identify and reduce possible medication problems. To help members get the best results from their medications, Banner Medicare Advantage contracts with Express Scripts to receive MTM Services. Express Scripts partners with MTM vendors to complete member outreach. The vendors may include Outcomes®, MedWatchers, and/or Arine.
To take part in this program, you must meet certain 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. 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 the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.
To qualify for Banner Medicare Advantage’s MTM program, you must meet one of the two following criteria:
1. Be considered at highest risk of adverse events or overdose related to opioid use and part of our Drug Management Program or
2. Meet all of the following criteria:
- Have at least 3 of the following conditions or diseases:
- Alzheimer’s Disease
- Bone Disease-Arthritis (Osteoporosis, Osteoarthritis, and Rheumatoid Arthritis)
- Chronic Heart Failure (CHF)
- Diabetes
- Dyslipidemia
- End-Stage Renal Disease (ESRD)
- HIV/AIDS
- Hypertension
- Mental Health (Depression, Bipolar Disorder, Schizophrenia)
- Respiratory Disease (Asthma, Chronic Obstructive Pulmonary Disease (COPD) and
- Take at least 8 covered Part D medications, and
- Are likely to have medication costs of covered Part D medications greater than $1,623 per year.
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. This is a good time to ask any questions you have about the medication. If you have trouble remembering to take your medication, the pharmacist may be able to suggest ways to help you stay on track. If there are concerns about the dose or safety of a medication, the pharmacist will ask your permission to talk with your provider to find the best solution for you. The estimated time commitment is about 15-30 minutes.
- Comprehensive medication review: at least once per year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. The pharmacist will meet with you face-to-face or via phone to review your prescriptions, vitamins, herbals, supplements and other over-the-counter medications. The pharmacist looks for potential medication conflicts, duplications, side effects or ways to save you money. You can ask any questions you have about your medications. After the review, the pharmacist will work with you, and your provider if necessary, to resolve any medication-related concerns. The estimated time commitment is about 15-30 minutes. Following the review, you will get a written summary of this call, which you can take with you when you talk with your providers. This summary includes:
- Recommended To-Do List (TDL): The list has steps you should take to help you get the best results from your medications.
- Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.
The Personal Medication List (PML) can help you and your health care providers keep track of the medications you are taking, Obtain a blank copy below.
If you take many medications for more than one chronic health condition contact your drug plan to see if you are eligible for MTM, or for more information, please contact our Customer Care Center, 8 a.m. to 8 p.m., seven days a week:
Banner Medicare Advantage Dual HMO D-SNP: 877-874-3930, TTY 711
Banner Medicare Advantage Prime HMO: 844-549-1857, TTY 711