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)
- Bone diseases such as osteoarthritis, osteoporosis, or rheumatoid arthritis
2. Take eight or more Part D (prescription) medications
3. Spend an expected total of more than $4,935 in 2023 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
