Medication Therapy Management (MTM)
If you're in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.
What is the MTM program?
The MTM program is a service offered by Native Advantage HMO at no additional cost to you. It is required by the Centers for Medicare and Medicaid Services (CMS). It is not part of your pharmacy benefit.
Your enrollment in MTM is voluntary. It does not affect Medicare coverage for drugs covered under Medicare. If you meet the criteria, we will send you a letter inviting you to take part in the program, along with information and instructions on how to access it. You can leave the program at any time.
Program Eligibility
To qualify for the Native Advantage HMO MTM program, you must meet the requirements for at least one of the following two groups:
Group 1: Members with complex health needs
Meet all 3 requirementsChronic Conditions
Have at least three of the following conditions or diseases:
- Alzheimer's Disease
- Bone Disease-Arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
- Chronic congestive heart failure (CHF)
- Diabetes
- Dyslipidemia
- End-Stage Renal Disease (ESRD)
- Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
- Hypertension
- Mental Health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
- Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
Multiple MedicationsTake at least eight (8) covered Medicare Part D medications.
Medication CostsAre likely to have greater than $1,340 per year in covered Medicare Part D medication costs.
Group 2: At-Risk Beneficiaries (ARB)
Alternative pathwayYou qualify if you are enrolled in the Native Advantage HMO Drug Management Program as an At-Risk Beneficiary (ARB). This program helps members safely use their prescription opioid medications, and other medications that are frequently abused.
Learn about Medicare Part D Drug Management Programs on CMS.gov(opens in a new tab)Services Offered
To help reduce the risk of possible problems, our MTM program offers two types of clinical reviews:
Targeted Medication Review (TMR)
At least every three months, we will review all your prescription medications and may contact your doctor if we identify a potential problem.
Comprehensive Medication Review (CMR)
At least once per year, we offer a free discussion and review of all your medications by a clinician or other health professional to help you use your medications safely. This service is provided to you confidentially on behalf of Native Advantage HMO via telephone by a Navitus Clinical Engagement Center clinician. The CMR may also be provided in person at your provider's office, pharmacy, or long-term care facility. The conversation usually lasts about 15 minutes.
The CMR includes a written summary with:
- •Recommended To-Do-List (TDL) / Medication Action Plan (MAP)
Steps you should take to help you get the best results from your medications. - •Personal Medication List (PML)
The PML will help you and your health care providers keep track of your medications. It explains how to use your medications the right way.
Contact the MTM Program
If you take several medications for multiple chronic health conditions, please contact the Navitus Medication Therapy Management (MTM) program team to see if you're eligible.
Hours of Operation
Monday – Thursday
8:00 a.m. to 7:00 p.m. CT
Friday
8:00 a.m. to 5:00 p.m. CT