2023 Medication Therapy Management Program

View the 2023 MTM program information.

View and/or print the 2023 Medicare Personal Medication List.

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management program, or MTM. MTM is a clinical program that provides education and information about your medications.  It is designed to ensure that covered Part D drugs prescribed to targeted members are appropriately used to optimize therapeutic outcomes through improved medication use and to reduce the risk of adverse events, including adverse drug interactions.

MTM is a service offered by SummaCare at no additional cost to you!  Participation in the program is voluntary and does not change your drug coverage benefit. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS). 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, you will be invited to participate in the program. We will then send you information about the program and how to request your Comprehensive Medication Review (CMR).  Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

To qualify for SummaCare’s MTM program, you must meet ALL of the following three criteria and/or be considered an at risk beneficiary (ARB) who is determined to be at-risk for misuse or abuse of frequently abused drugs:

1. Enrollees must have at least 3 or more of the following conditions or diseases: Chronic Heart Failure, Diabetes, Dyslipidemia, Hypertension, Respiratory Disease – Asthma, or Respiratory Disease - Chronic Obstructive Pulmonary Disease (COPD), Bone Disease – Arthritis – Osteoporosis, or Bone Disease – Arthritis – Rheumatoid Arthritis; AND
2. Enrollees must take at least 8 covered Part D medications (chronic/maintenance drugs apply); AND
3. Enrollees must have incurred one-fourth of the specified annual cost threshold ($4,935) for covered Part D drugs in the previous three months.

SummaCare delegates MTM services to OutcomesMTM. OutcomesMTM provides this service through an interactive, person-to-person consultation with an MTM provider that may be delivered face-to-face, via phone, or by telehealth. They utilize local pharmacists who patients know and trust in their neighborhood and a pharmacist-run call center staffed by experienced medication management specialists certified in a number of clinical areas including geriatric medication management.

Enrollees who meet the criteria above will be automatically enrolled in the MTM program and will receive an introductory letter in the mail from OutcomesMTM. The letter will provide an explanation of the MTM program and will include a toll free number that enrollees can call to schedule their Comprehensive Medication Review, or CMR. This number can also be used to opt out of the program.  The letter also provides the name, phone number, and location of a local pharmacy that you can call to schedule an in person review of your medications. This review can be done in person or over the phone with your local pharmacist. They may also reach out to you via a phone call regarding your eligibility for a CMR. A telehealth option may be available from certain providers. Information regarding the safe disposal of prescription drugs that are controlled substances, including opioids will also be sent on enrollment with the offer letter.

CMRs for newly targeted enrollees will be offered as soon as possible after enrollment into the MTM program, but no later than 60 days after being enrolled into the MTM program. Enrollees that request a CMR can have either a telephone appointment or a face to face appointment scheduled for a one-on-one consultation with a pharmacist. During the CMR, the enrollee’s entire medication profile is reviewed (including prescriptions, over the counter medications, herbal supplements, and samples) for appropriateness of therapy. Disease-specific goals of therapy and medication-related problems are discussed with the enrollee as well as any member-specific questions. After the CMR, the enrollee is provided a CMR takeaway letter which includes a Medication Action Plan and Personal Medication List detailing the conversation with the pharmacist.

All enrollees that have not opted-out of the program will receive ongoing Targeted Medication Reviews (TMR).TMRs are performed at least quarterly to assess medication use since the CMR. In addition, TMRs monitor whether any unresolved issues need attention, if new drug therapy problems have arisen, or if the beneficiary has experienced a transition in care. TMR categories include, but are not limited to, cost savings, safety concerns, and adherence to national treatment guidelines. The specific interventions will be determined by SummaCare with recommendations from designated OutcomesMTM pharmacists targeting SummaCare’s MTM program objectives. Ambulatory MTM program participants (and Care Management Coordinators, if applicable) may also be contacted by phone for a person-to-person consultation to discuss recommendations regarding cost savings substitution, safety concern and adherence to national treatment guidelines. Likewise, the prescriber(s) will be provided a copy of these recommendations.

If you have any questions regarding SummaCare’s MTM Program or how to obtain MTM service documents, please contact SummaCare Medicare Customer Service at 330.996.8885 or (toll free) 800.996.6250 for additional information. TTY users should call 800.750.0750. From April 1 through September 30, a representative will be available to speak with you from 8 a.m. to 8 p.m., Monday through Friday. Beginning October 1 through March 31, a representative will be available to speak with you from 8 a.m. to 8 p.m., seven days a week.