FirstMedicare Direct  
 

 

Medication Therapy Management (MTM) Program Description

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 (MTM) program. MTM is a service offered by FirstMedicare Direct at no additional cost to you! The MTM program is required by the Centers for Medicare and Medicaid Services (CMS). This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.

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 and we will send you 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 the MTM program, you must meet ALL of the following criteria:

  1. Have at least 3 of the following chronic conditions or diseases: Chronic Heart Failure (CHF), Diabetes, Dyslipidemia, Hypertension, Asthma, Chronic Obstructive Pulmonary Disease (COPD), AND
  2. Take at least 8 covered Part D medications, AND
  3. Are likely to have medication costs of covered Part D medications equal to or greater than $4,044.00 for 2019 and $4,255.00 for 2020.

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, by phone or mail, and/or your doctor if we detect a potential problem.
   
 •  Comprehensive medication review: at least once a 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. This review, called a CMR, is provided to you confidentially via telephone by FirstMedicareDirect’ s MTM vendor (Clinical Support Services or CSS). This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:
   
     •  Medication Action Plan (MAP): The action plan 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.
 

If you take many medications for more than one chronic health condition contact FirstMedicare Direct to see if you’re eligible for MTM, or for more information, please contact Member Service at 844-201-4957 (select member prescription drug option). This line is available 24 hours a day, seven days a week. TTY users should call 711.

For a personal medication list form, please click here Adobe PDF.


Get Adobe Reader To view PDF documents you need Adobe Acrobat Reader.

FirstCarolinaCare Insurance Company’s FirstMedicare Direct plans are HMO and PPO plans with a Medicare contract. Enrollment in a FirstMedicare Direct plan depends on contract renewal.This is a required statement by CMS. FirstCarolinaCare has filed and been approved to offer an HMO and a PPO Medicare Advantage Prescription Drug plan for 2020.

 
Y0094_20042M_Accepted_10/01/2019

Page Last Updated:
Friday, October 2, 2020 11:13:12 AM