There are certain initials for services floating around the pharmacy industry. The latest one that is now a battle-cry for the pharmacy profession is “MTM”. To a pharmacist, this is no secret code; however, to the patient, it is totally unfamiliar and can be confusing.

MTM are the initials for “M”edication “T”herapy “M”anagement. This professional service has been building in the pharmacy profession since the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act (“MMA” for short) of 2003. This act provided medication coverage for Medicare beneficiaries and included a provision to pay for healthcare professionals to perform MTM services to those beneficiaries who were considered to be high-risk for medication-related problems. As the most highly trained medication experts in the healthcare field, pharmacists began seizing this new opportunity to provide these services.

However, most Medicare patients do not know about these services, their cost, their eligibility to participate and, most of all, the value. It’s almost as if their Medicare plans do not want them to know about it. In 2010, new Medicare rules took effect that allowed a quarterly assessment of a beneficiary’s medications at no charge providing certain criteria are met. This means that the beneficiary’s drug plan pays for the MTM service. It is also mandated that every Medicare-subsidized drug plan provide an MTM program for its members. This is the government’s way of keeping drug-related expenses down. The sad part is that most plans and their subscribers are not taking advantage of it, and the reason is due to a lack of awareness.

So, here is what to ask for when you enroll in a Medicare Part D program for medication assistance:  a) do you have an MTM program (a structured program to optimize therapeutic outcomes) and, if so, b) how often and by whom is the MTM service (a patient-centered assessment of the medication regimen and identification of medication-related problems) provided? While the act says “healthcare professionals” can provide the service, it would be in your best interest to have at the very least, a trained MTM (or MTM- certified) pharmacist perform the service. The value of this service, when performed properly, is quite remarkable as patients can usually cut their medication cost significantly. This is a winning situation for all involved parties: the patient, the insurance company, the pharmacist and the federal government. So don’t be left in the dark about what you are entitled.  Ask your Medicare plan for the service to help you stay healthy. In addition, this service is also available for non-Medicare patients, and it is not subsidized by Medicare. If you need this type of service, ask you local pharmacist if they can provide it, or drop me an email, and I will contact you.

Until next week, stay well.

Dion