Medication Therapy Management (MTM) Program

If you’re enrolled in a Medicare drug plan and have complex health needs, you may be eligible to participate in the Medication Therapy Management (MTM) Program. This service is provided at no additional cost by El Paso Health Medicare Advantage Dual (HMO D-SNP), as required by the Centers for Medicare and Medicaid Services (CMS). Please note, this is not considered a Medicare benefit.

What is the MTM Program?

The MTM Program helps ensure your medications are working as intended and helps reduce the risk of medication-related issues. It offers personalized support to help you and your healthcare provider get the most benefit from your medications.

Enrollment in the MTM Program is voluntary and does not affect your Medicare drug coverage. If you do not wish to participate, please let us know and we will remove you from the program. You may opt out at any time.

Eligibility

To qualify for the MTM Program, you must meet the requirements for at least one of the following two groups:

  1. Meet all three of the following conditions:
    • Have at least three of the following conditions or diseases:
      • Alzheimer’s Disease
      • Bone Disease (osteoporosis, osteoarthritis, rheumatoid arthritis)
      • Congestive Heart Failure
      • Diabetes
      • Dyslipidemia
      • End-Stage Renal Disease
      • HIV/AIDS
      • Hypertension
      • Mental Health conditions (depression, schizophrenia, bipolar disorder, or other chronic/disabling mental health conditions)
      • Respiratory Disease (asthma, chronic obstructive pulmonary disease [COPD], or other chronic lung disorders)
    • Take at least eight covered Medicare Part D medications
    • Be likely to incur more than $4,255 per year in covered Medicare Part D medication costs
  2. Be enrolled in the Drug Management Program as an At-Risk Beneficiary (ARB): This program helps our members safely use their prescription opioid medications and other medications that are frequently abused.

Program Services

The MTM Program offers two types of reviews:

  • Targeted Medication Review: Conducted at least quarterly to identify potential medication-related problems. We may contact you, your caregiver, pharmacist, or doctor if necessary.
  • Comprehensive Medication Review (CMR): A once-yearly confidential review of all your medications with a licensed pharmacist or health professional. This review is provided on behalf of El Paso Health Medicare Advantage Dual (HMO D-SNP) by SinfoníaRx and can be completed via telephone, telehealth, or in person at your provider’s location. If you or your caregiver are unable to participate, the review may be completed with your provider.

The CMR typically takes about 30 minutes. Afterward, you’ll receive a written summary including:

  • Medication Action Plan (MAP): A to-do list with steps to optimize your medication use.
  • Personal Medication List (PML): A helpful reference to track your medications and usage instructions.

You can download a blank copy of the Personal Medication List below:

Next Steps

If you take multiple medications and have more than one chronic condition, contact us to check your eligibility. Call Member Services at 1-833-742-3125 (TTY 711), 7 days a week. From April 1 to September 30, hours are Monday through Friday, 8:00 a.m. to 8:00 p.m. Mountain Time.

H3407_website CMS Accepted 10/09/2019 | Last Updated: 10/17/2024