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  • Medication Therapy Management Program

    The Medication Therapy Management (MTM) Program helps you get the best results with your medications while keeping your costs down. Through MTM, a pharmacist will review all your medications and provide the extra attention you need to keep your medications on the right track. The MTM program is provided at no additional cost to you and is not considered a benefit.

    MTM Services

    Through the MTM program, you may receive the following services:

    Comprehensive Medication Review (CMR)  A pharmacist will meet with you face-to-face or via phone to review all your medications for

    problems and help to organize your medication schedule. They may also recommend lower cost alternatives to your medications.

     Following the CMR, you will receive a Medication Action Plan and Personal Medication List.  Estimated Time to Complete: 15 -30 minutes

    Targeted Medication Review (TMR)  Your medications will be reviewed every 3 months to look for any serious concerns related

    to your medications. A pharmacist will reach out to you if a serious concern is found.

    Prescriber Consult:  A pharmacist will work with your doctor(s) to resolve any concerns or problems found with

    your medications.

    How to Join

    First, you must qualify for MTM by meeting all 3 of the following:

    1. You have a total drug cost of over $4,255 a year 2. You take 8 or more long term medications 3. You have at least 3 of the following long-term diseases:

    o Heart Failure o Diabetes o High Cholesterol o High Blood Pressure o Osteoporosis o Rheumatoid Arthritis o Asthma o COPD (Chronic Obstructive Pulmonary Disease) o HIV/AIDS o Depression

  • If you qualify, we will contact you by mail. An MTM Personal Pharmacist may also contact you at your pharmacy or by phone. To get started or if you have questions, call 1-800-541-8981. Ask about the locations of MTM Personal Pharmacists in your area.

    Joining the MTM program is voluntary. Keep in mind that the program is helpful in:

     preventing side effects.  helping you save money.  making sure your medications are safe and are working well for you.

    As your health changes, you may want a pharmacist to review your medications. If you decide to opt out of this helpful service, you may call 1-800-541-8981.

    Frequently Asked Questions:

    Where can I find a pharmacist who provides these MTM services? Call us at 1-800-541-8981 or visit http://outcomesmtm.com/.

    Who are the MTM Personal Pharmacists? MTM Personal Pharmacists may be a pharmacist at your local pharmacy, a pharmacist at your doctor's office or a pharmacist we contract with.

    Are all pharmacists in the Asuris network also MTM pharmacists? Not all pharmacists in the Asuris pharmacy network provide MTM services. Our MTM Personal Pharmacists have completed special training to provide these extra services.

    Can I use my regular pharmacy and still visit an MTM pharmacist too? Yes. MTM services are an added value of membership. You may continue to use any Asuris participating pharmacy for your prescriptions.

    Can a pharmacist save me money? Yes. Similar medications may be available at lower costs. Your pharmacist can help you look for less costly medications.

    Will my doctor know if any changes need to be made to my prescriptions? Yes. Your pharmacist may make recommendations to you and your doctor(s) – but only your doctor can change your prescription.

    Will I be required to use an MTM pharmacist? No. MTM services through a specially trained pharmacist are an added service of membership. They are there to help, but you are not required to use them.

    A pharmacist from Cardinal Health called me. Is that different from Asuris? Cardinal Health pharmacists are contracted with Asuris to provide MTM services when you are unable to receive MTM services at your pharmacy. These pharmacists can also help you with getting the best results from your medications.

    http:http://outcomesmtm.com

  • < MTM PROVIDER HEADER or OPTIONAL LOGO >

    < MTM PROVIDER HEADER or OPTIONAL LOGO>

    I PERSONAL MEDICATION LIST FOR< Insert Member's name, DOB: mm/dd/yyyy >

    This medication list was made for you after we talked. We also used information from< insert sources of iriformation >.

    • Use blank rows to add new medications. Then fill in the dates you started using them.

    Keep this list up-to-date with:

    prescription medications • Cross out medications when you no

    longer use them. Then write the date and why you stopped using them.

    over the counter drugs

    • Ask your doctors, pharmacists, and other healthcare providers in your care team to update this list at every visit.

    herbals vitamins minerals

    If you go to the hospital or emergency room, take this list with you. with your family or caregivers too.

    Share this

    DATEPREPARED: Allergies or side effects: < Insert beneficiary's allergies and adverse drug reactions including the medications and their effects >

    Medication: < Insert generic name and brand name, strength, and dosage form for current/active medications.> How I use it: < Insert regimen, including strength, dose and frequency (e.g., 1 tablet (20 mg) by mouth daily), use of related devices and supplemental instructions as appropriate > Why I use it: < Insert indication or Prescriber: < Insert prescriber's name intended medical use > > < Insert other title(s) or delete this field>: < Use for optional product-related iriformation, such as additional instructions, product image/identifiers, goals of therapy, pharmacy, etc., and change field title accordingly. This field may be expanded or divided. Delete this field if not used. > Date I started using it: < May be Date I stopped using it: < Leave blank estimated by Plan or entered based for beneficiary to enter stop date > upon beneficiary-reported data, or leave blank for beneficiary to enter start date > Why I stopped using it: < Leave blank for beneficiary's notes>

    Form CMS-10396 (08/17) Form Approved 0MB No. 0938-1154

    Page 1 of3

  • I PERSONAL MEDICATION LIST FOR< Insert Member's name, DOB: mm/dd/yyyy > (Continued)

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this field >: Date I started using it: I Date I stopped using it: Why I stopped using it:

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this_field >: Date I started using it: I Date I stopped using it: Why I stopped using it:

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this field >: Date I started using it: I Date I stopped using it: Why I stopped using it:

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this field>: Date I started using it: I Date I stopped using it: Why I stopped usin2 it:

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this_field >: Date I started usin2 it: I Date I stopped usin2 it: Why I stopped using it:

    Form CMS-10396 (08/17) Form Approved 0MB No. 0938-1154

    Page 2 of3

  • I PERSONAL MEDICATION LIST FOR< Insert Member's name, DOB: mm/dd/yyyy > (Continued)

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this field >: Date I started using it: I Date I stopped using it: Why I stopped using it:

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this_field >: Date I started using it: I Date I stopped using it: Why I stopped using it:

    Medication: How I use it: Why I use it: I Prescriber: < Insert other title(s) or delete this field >: Date I started using it: I Date I stopped using it: Why I stopped using it:

    Other Information:

    If you have any questions about your medication list, call < insert MTM provider contact information, phone numbers, days/times, etc. >.

    According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid 0MB control number. The valid 0MB number for this information collection is 0938-1154. The time required to complete this information collection is estimated to average 40 minutes per response, including the time to review instructions, searching existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Form CMS-10396 (08/17) Form Approved 0MB No. 0938-1154

    Page 3 of3

    MTM Website Content_ASURIS_20190816 PML

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