MEDICATION THERAPY MANAGEMENT
What is Medication Therapy Management?
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.
The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit, however, MTM is a service offered by Zing Health at no additional cost to you! This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.
How do I qualify for MTM?
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, we will send you a letter inviting you to participate in the program and 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 Zing Health’s MTM program, you must meet ALL of the following criteria:
1.Have at least 3 of the following conditions or diseases:
- Asthma
- Bone Disease-Arthritis-Osteoarthritis
- Chronic Alcohol and Other Drug Dependence
- Chronic Heart Failure (CHF)
- Chronic Non-Cancer Pain
- Chronic Obstructive Pulmonary Disease (COPD)
- Depression
- Diabetes
- Dyslipidemia
- End-Stage Renal Disease (ESRD)
- HIV/AIDS
- Hypertension
2. Take at least 8 covered Part D maintenance medications
3. Are likely to have Part D-covered drug costs of at least $4,935 per year.
4. At risk beneficiaries (ARBs) with an active drug management program coverage limitation (Opioid Safety).
What is included in the program?
To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:
Targeted Medication Review (TMR): at least quarterly, we will review all your prescription medications and contact you, your caregiver, your pharmacist, and/or your doctor if we detect a potential problem.
Comprehensive Medication Review (CMR): at least once per year, we offer a free discussion and review of all your medications by a pharmacist or other health professional to help you use your medications safely. This review, or CMR, is provided to you confidentially via telephone by licensed professionals employed by our pharmacy benefits manager (PBM) Elixir. The CMR may also be provided in person or via telehealth at your provider’s office, pharmacy, or long-term care facility. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider. These services are provided on behalf of Zing Health. This review requires about 30 minutes of your time. Following the review, you will get a written copy of the CMR Recommendation Letter. This recommendation letter 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.
To obtain a blank copy of the Personal Medication List (PML) that can help you and your health care providers keep track of the medications you are taking, click here.
If you take many medications for more than one chronic health condition and would like to see if you’re eligible for MTM, or for more information, please contact Customer Service at 1-866-946-4458.
