Medication Therapy Management Program

What Should I Expect?

After receiving and accepting an invitation by mail from KelseyCare Advantage to participate in the MTM program.

• A KelseyCare Advantage representative will call you to set up a one-on-one review with a health plan pharmacist who is knowledgeable about your Part D benefits.
• All medication reviews are typically 30 minutes and are completed over the phone in the privacy of your own home.
• The pharmacist will coordinate and collaborate with your physician on your medication plan.
• After the medication review, you’ll receive a written summary of the discussion, including a medication action plan with recommendations.
• You’ll also get a personal medication record that will include all the medications you’re taking and why you take them, which you can share with your healthcare providers.
• The medication reviews will continue each quarter to make sure you’re still getting the most benefit from your medications.
   

How Will I Qualify?

To qualify for this program, you are required to meet one of the following CMS directed MTM Criteria:
1. Have any three of the following chronic diseases:

• Alzheimer’s disease
• Chronic heart failure (CHF)
• Diabetes
• Hepatitis C
• HIV/AIDS
• Multiple sclerosis
• Respiratory diseases such as asthma, chronic lung disorders, or chronic obstructive pulmonary disease (COPD).
• Atrial Fibrillation
• Rheumatoid arthritis.

2. Take eight or more Part D (prescription) medications.

3. Spend an expected total of more than $5,330 in 2024 per year for Part D medications (the expected total is the amount paid by the plan for Part D medications, added to the amount the member pays).

Included Services

The MTM program provides a broad range of services, including but not limited to:

• Conducting patient assessment and/or a comprehensive medication review (CMR).
• Formulating a medication action plan (MAP).
• Developing a personalized medication record (PMR).
• Monitoring efficacy and safety of medication therapy through targeted medication reviews (TMR).
• Enhancing medication adherence.
• Coordinating care with your physicians.

View and print samples of MTM service documents:

Sample Medication Action Plan and Personal Medication Record