This page currently provides information about MTM, MTM vendors and Medicare Part D MTM programs offered in Tennessee.

At the present time, all information and links on this page are accessible without a TPA username and password. 

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What is Medication Therapy Management (MTM)?
With the passing of the Medicare Modernization Act (MMA) of 2003, all Medicare Advantage and Prescription Drug Plan providers offering Medicare Part D benefits are now required to provide MTM services to beneficiaries.

According to the MMA of 2003, an MTM program is a program of drug therapy management that may be furnished by a pharmacist and is designed to assure that the drugs of Medicare beneficiaries are appropriately used to optimize therapeutic outcome and to reduce adverse drug events.

MTM in the community pharmacy consists of five components:

• Medication Therapy Review

• Personal Medication Record

• Medication Action Plan

• Intervention and Referral

• Documentation and Follow-up

Who is Eligible for MTM?
Medicare Part D beneficiaries that meet the following criteria are eligible for MTM services:

• have multiple chronic diseases (such as diabetes, asthma, hypertension, hyperlipidemia, and congestive heart failure)

• are taking multiple Part D covered drugs

• are likely to incur annual costs for covered Part D drugs that exceed a specified level (approx. $4000)

MIRIXA
Mirixa provides pharmacies with the opportunity to produce income outside of the traditional dispensing and merchandising business model. As pharmacies restructure and expand their patient care services, Mirixa solves the clinical integration challenges with an on-demand software suite, delivered through its MirixaPro^SM application, which delivers qualified patient-based revenue opportunities to its pharmacy members, streamlines patient intervention delivery, and enhances clinical documentation and payment for services rendered.

• Mirixa Pharmacy FAQ Sheet

• Contracting and Training with Mirixa

• Preparing for MTM Session

• Long Term Care FAQ Sheet

Plans currently using Mirixa to deliver MTM services to their beneficiaries are BlueCross Blue Shield of Alabama and Tennessee/Preferred Care Services MTM Program and CCRx:

— BlueCross BlueShield of Alabama and Tennessee/Preferred Care Services MTM Program:
Preferred Care Services, Inc. (PCSI) d/b/a Blue Cross and Blue Shield of Alabama within the states of Alabama and Tennessee, Partners with Mirixa, to Deliver Medication Therapy Management.

Patient Eligibility and Pharmacy Reimbursements

• In order to be eligible for participation in the PCSI MTM program, patients must:

  • Have a diagnosis of diabetes, high cholesterol, and hypertension

  • Use at least three prescription medications related to those diagnoses, and

  • Be likely to incur at least $4,000 in annual drug costs

• Your pharmacy will be reimbursed $60 for the initial 30-minute consultation

• If necessary, an additional 15-minute follow-up intervention can be scheduled and is reimbursed at $30

Pharmacist Resources

• Mirixa BCBS Fact Sheet

• BlueRx Blue Advantage Program Service Description

• BlueRx Blue Advantage MTM Encounter Guide

— CCRx: 
In 2005, NCPA collaborated with MemberHealth, LLC, and Computer Sciences Corporation to create Community CCRx^SM, one of the nation’s top Medicare Part D prescription drug plans. As an innovative Part D prescription drug plan, Community CCRx recognizes the value of the pharmacist-patient relationship and proudly serves Medicare beneficiaries in the United States, Puerto Rico, and the U.S. Virgin Islands.

In addition to providing prescription drug coverage, Community CCRx also began powering Medicare Advantage plans beginning in 2008. The new plans are being offered through MemberHealth’s parent company, Universal American, and are marketed under the name Today’s Options® powered by CCRx^SM.

• To learn more about Today’s Options powered by CCRx, view a brief 10-minute presentation here.

• To learn more about Medicare Advantage plans in general, take NCPA's 1.5-hour CE program entitled "Opportunities in Medicare Part D: A Fresh Look at Medicare Advantage Plans" on the Medicare Resource Center Web site

Pharmacist Resources
Pharmacists are invited to receive the latest Community CCRx plan updates, formulary information, and general Medicare Part D news from the CCRx Update electronic newsletter. To subscribe and have it delivered weekly to your e-mail inbox, please e-mail your name to jennifer.bruckart@ncpanet.org.

Below please find a list of helpful resources for the 2008 plan year.

• 2008 Community CCRx Marketing Materials Order Form

• 2008 Community CCRx Quick Enrollment Form (for pharmacist use)

• 2008 Community CCRx Prior Authorization (PA) Formulary Forms

• 2008 Community CCRx Formularies (printable)

For additional information about Community CCRx plan designs, formularies, and enrollment, please visit www.CCRx.net or call the Pharmacy Technical Center at (866) 684-5395.

OUTCOMES PHARMACEUTICAL HEALTH CARE:
Outcomes offers a comprehensive system for the delivery, documentation, billing and administration of MTM. More information about the following can be found here:

• Covered Services

• Targeted Intervention Program (TIP)

• National MTM Network

• Pharmacist Training

• Electronic Charting Platform

• Network Support

• Quality Assurance

• Data and Reporting

• Payment Processing

Outcomes Fact Sheet

Plans currently using Outcomes to deliver MTM services to their beneficiaries are John Deere Health Care, HealthSpring:

— John Deere Health Care
Program information can be found here.

— HealthSpring
Program information can be found here.

HUMANA MTM PROGRAM
Humana is excited to offer an MTM program that meets the needs of its members. Core to Humana's MTM belief is the notion of improving the health literacy of its members and teaching them how to understand and optimize their medication therapy. To meet these objectives, Humana offers an MTM program to its members through monthly personalized mailings, call-center-based nurse consultations, and face-to-face consultations with a pharmacist.

• About MTM - Contains information about Humana’s MTM policies, procedures, and eligibility requirements

• MTM Resources - Contains information helpful to pharmacists providing MTM services

• Pharmacy Eligibility - Determine if your pharmacy is eligible to provide MTM services with Humana
   

Additional Resources

• American Pharmacists Association (APhA) MTM Resource Page

• National Association of Chain Drug Stores (NACDS) MTM Resource Page

• Minnesota Pharmacists Association MTM Toolkit

• APhA/NACDS Core Elements of an MTM Service

• The Lewin Report: A Critical Review of MTM

• Sound MTM Programs – Version 2.0 with Validation Study

Information about other MTM programs, as well as general information about Medication Therapy Management, will be included on this page in the near future.
 

Tennessee Pharmacists Association
500 Church Street, Suite 650, Nashville, TN 37219
615-256-3023 phone     615-255-3528 fax
tpa@tnpharm.org