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Medication Therapy Management (MTM) Program

What is the Medication Therapy Management (MTM) Program?

It is a program for Medicare Part D members to learn more about their medicines. This helps ensure safe use of medications.

Who is eligible?

You must meet ALL of the following criteria to be eligible for MTM services:
  • Have Medicare Part D coverage
  • Have at least 3 of the chronic diseases listed below.
    • Alzheimer’s Disease
    • Osteoarthritis
    • Osteoporosis
    • Rheumatoid Arthritis
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia (high cholesterol)
    • Hypertension (high blood pressure)
    • Bipolar Disorder
    • Depression
    • Schizophrenia
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
  • Take at least 8 chronic / maintenance medications covered by your Medicare Part D plan.
  • Be likely to spend a certain amount on Part D covered drugs each year.  For 2020, you must be likely to spend $4,255.

Is there a fee for MTM services?

There is no fee for MTM services if you meet the above criteria.

Who provides the MTM services?

A company called SinfoniaRx provides the MTM services. SinfoniaRx has specially trained MTM providers.

What types of MTM services are offered?

  1. A Comprehensive Medication Review (CMR) once a year
    • A CMR can help you learn more about your medications.  This includes over the counter (OTC) products and supplements.
    • During a CMR, a qualified MTM provider talks with you and reviews your medications. The MTM provider works with you to create a plan to address any medication problems.  If you are not able to participate in a CMR, or do not manage your own medications, Sinfonia may reach out to complete a CMR with your doctor or other healthcare provider instead.
    • After a CMR, you will be provided a written summary.  That summary will be delivered by mail and will include the following materials:
      • Cover Letter (CL)
      • Medication Action Plan (MAP)
      • Personal Medication List (PML)
    • Where are CMR visits conducted?
      • Sinfonia will speak with you on the phone.
    • How long is a CMR visit?
      • The time required to conduct a CMR depends on many factors.  Typically, a CMR takes less than 30 min.
  2. Targeted Medication Reviews (TMR) at least every 3 months
    • These reviews help to ensure safe use of medications. These reviews may focus on one drug or many drugs.
    • Your medications will be reviewed to see if you may be taking the targeted medication(s). If a medication problem is found during the review, you or your doctor will be notified by phone, mail, or fax.

How do patients enroll?

MTM services are not a benefit for all Part D members, but are offered for free to members who qualify for the plan’s MTM program.

Once you are eligible for the MTM program, you are automatically enrolled.

You will be sent a welcome letter inviting you to take part in a CMR. The letter will describe the MTM program and describe how to schedule a CMR. You may also get a phone call inviting you to schedule a CMR. You may disenroll from the MTM program at any time. You may also refuse certain services and still stay enrolled in the MTM program. For example, you can refuse to schedule a CMR but stay in the MTM program. In this case, your medications would still be screened during the TMRs.

For more information

To learn more about the MTM program or to see if you are eligible for the program, call FirstCare Advantage Dual SNP (HMO SNP) Customer Service at 1-866-229-4969 (TTY users 7-1-1).

If you do not have questions about the MTM program but have questions regarding your Medicare benefit, contact FirstCare Advantage Dual SNP (HMO SNP) Customer Service at 1-866-229-4969 (TTY users 7-1-1).

We are available:
  • October 1 – March 31, 8 a.m. to 8 p.m. Central Time (CT) daily;
  • April 1 – September 30, 8 a.m. to 8 p.m. Central Time (CT) Monday through Friday.

Personal Medication List

It is important to keep a list of your medications. Feel free to print and use the medication list templates below. If you take OTC medications or supplements, include these on your list too. Be sure to share your medication list with each of your healthcare providers.

Resources

Access a Doctor, 24/7/365

FirstCare Virtual Care—powered by MDLIVE lets you connect with a doctor from wherever you are. For more details, click here.

Talk to a Nurse—Nurse24™

Need care advice? Should you see a doctor? Get the info you need today! FirstCare members can talk to a nurse 24/7 by calling 1-855-828-1013 to get answers 24 hours a day, 7 days a week! TTY users can call 7-1-1 or  1-800-955-8771. Voice communication is available at 1-800-955-8770.

Utilization Management

Ever wonder how we decide what services to authorize? Our utilization management (UM) decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

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How to Learn More

Schedule a sit-down:
Feel free to contact us, and a FirstCare Advantage Dual SNP (HMO SNP) representative will gladly sit down with you and compare the plans in greater detail.
 
Call us at:
1-866-229-4969
We are available;
October 1- March 31, 8 a.m. to 8 p.m. Central Time (CT) daily;
April 1- September 30, 8 a.m. to 8 p.m. Central Time (CT) Monday through Friday.
 
For TTY or for accommodation of persons with special needs, please call TTY 7-1-1.
 
Or, write:
FirstCare Advantage Dual SNP (HMO SNP)
Attn:  Customer Service
1901 West Loop 289, Suite 9
Lubbock, TX 79407

"What's Covered" App
Centers for Medicare & Medicaid Services (CMS) has an app that gives you access to content about original Medicare. For more information, click here.

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