Medication Therapy Management (MTM) is a program for members with complex medical conditions. The program helps you to safely manage your medications.
If you have at least three (3) chronic conditions and take at least seven (7) long-term drugs that cost more than $4,255 per year, you may be eligible. The program is not considered a benefit and is free to all members. You’re not required to participate, but we encourage you to.
If you qualify for the program, we’ll send you a letter with more information about the program. If you join, a pharmacist will meet with you to go over all your prescription drugs and give you a Comprehensive Medication Review (CMR). The pharmacist will look at how your medications work together and may suggest ways to make it easier for you to take them. You’ll get a Personal Medication List (PML) with instructions you can share with your doctors and caregivers. The appointment should last about 20 minutes.
As part of the CMR, the pharmacist may also help you with specific drug-related issues, called a Targeted Medication Review (TMR). The TMR will identify any drug therapy issues and may recommend alternatives to your provider. If you are unable to travel to a pharmacy, contact Member Services to schedule a telephone medication review with a pharmacist.
You can ask your pharmacist if he or she is an OutcomesMTM pharmacist. OutcomesMTM works with SWH to provide this service. If your pharmacy doesn’t participate or you want to speak to another pharmacist, please call Member Services at 1-877-353-0185 (TTY 711) from Monday through Friday, from 8 a.m. to 8 p.m. (from October 1 – March 31, 7 days a week). If you choose another pharmacy for this service, you can still continue to fill your prescriptions at the pharmacy you currently use.
*Qualifying chronic conditions include: Rheumatoid arthritis, arthritis, chronic heart failure (CHF), diabetes, dyslipidemia, hypertension, chronic lung disorder, chronic obstructive pulmonary disease (COPD).