Medication Therapy Management Progam (MTM)

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Prescription Pathway's MTM program was developed to help ensure safe and proper medication use by Part D enrollees who have multiple chronic diseases (namely asthma and diabetes mellitus), take multiple Part D drugs, and are likely to incur annual costs for covered Part D drugs that exceed a predetermined level as specified by the Secretary.

1.  Criteria for enrollee eligibility include:

a.	Involvement of multiple chronic diseases;
b.	Necessity for multiple covered Part D drugs; and
c.	Likeliness to incur annual costs of at least $4,000 for covered Part D drugs.
d.	Projected utilization of at least seventy-three (73) Part D drugs per year.

2.  Enrollment

a.	Eligible enrollees receive a letter that explains the components of the MTM program and provides instructions for enrollment.
b.	Enrollment is voluntary. Members may enroll in the program by returning a postage paid response form, or by calling a toll-free enrollment number.

3.  Assessment

a.	Enrollees speak with an MTM program health care professional for an initial comprehensive consultation.
b.	This consultation includes a discussion of medication history, past medical history and current therapies.
c.	A therapy assessment worksheet (TAW) is completed. The health care professional reviews the TAW and develops a care plan, which incorporates risk stratification and coordination with any chronic care improvement program established for the enrollee.
d.	Enrollees receive customized educational materials, a customized care plan, a medication summary and a drug therapy assessment.
e.	Physicians receive an introductory letter describing the MTM program, the enrollee’s customized care plan, a drug therapy assessment and care considerations (conditional upon receipt of a signed release form).
f.	Enrollees are scheduled for a follow-up appointment four to six weeks after the initial consultation to review medication changes, the customized care plan and any specific monitoring parameters associated with individual disease states.

4.  Monitoring

a.	Enrollees and their cases will continue to be monitored and reviewed as long as they opt to participate in the program.

Utilization Management (UM)

Prescription Pathway’s UM programs are designed to open timely lines of communication with physicians, pharmacists and patients, and are intended to set in motion actions that subsequently result in increased quality of care.

1.	Prescription Pathway produces a variety of products and communications aimed at members and physicians. The function of these products primarily consists of formulary compliance, cost savings measures and educational materials designed to inform their users.

Last updated: 11/15/2007