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Medication Therapy Management

Medication Therapy Management Program

West Virginia Senior Advantage (HMO SNP)

What you should do if you wish to join the medication therapy management program

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 is a service offered by West Virginia Senior Advantage at no additional cost to you! The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.

To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

To qualify for West Virginia Senior Advantage MTM program, you must meet ALL of the following criteria:

  1. Have at least 3 of the following conditions or diseases:
    • Alzheimer’s Disease
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia
    • Hypertension
    • Mental Health-Depression
    • Respiratory Disease-Chronic Obstructive Pulmonary disease (COPD)
  2. Take at least 8 covered Part D medications
  3. Are likely to have medication costs of covered Part D medications greater than $4,225 per year.

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

  • Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor if we detect a potential problem.
  • Comprehensive medication review: at least quarterly, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely.  The CMR service is an interactive, person-to-person consultation delivered over the phone or face to face.  During the CMR appointment, the provider reviews the beneficiary’s allergies, medications, including prescription, non-prescription, and herbals/supplements.  The provider documents information provided by the beneficiary and any interventions conducted with the beneficiary or a prescriber.  At the conclusion of the CMR, an individualized, written summary of the interactive consultation is provided to the beneficiary, caregiver or other authorized representative (as appropriate).  These services are provided on behalf of West Virginia Senior Advantage. This summary includes:
    • Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications.
    • Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

If you take multiple medications for more than one chronic health condition, contact us to see if you’re eligible for MTM, or for more information, please contact Member Services at 1-833-665-5423 TTY users should call 711. Live representatives are available 24 hours a day, 7 days a week.