2016 Medication Therapy Management (MTM) Program
The Medication Therapy Management (MTM) Program is a component of Cigna-HealthSpring prescription drug plans and Cigna-HealthSpring Medicare Advantage medical plans with prescription drug coverage. The program may assist qualified customers who meet all of the following criteria:
- Customer must have at least 3 of the following medical conditions:
- chronic heart failure
- bone disease (osteoporosis)
- Customer should be taking ≥ 7 drugs from selected classes: oral hypoglycemics, insulins, antihyperglycemics, antihyperlipidemics, antihypertensives, angiotensin-converting-enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, alpha blockers, calcium channel blockers, diuretics, bisphosphonates, and other metabolic bone disease agents.
- Customer must have annual prescription costs higher than one-fourth of a specified cost threshold in the previous three months. The annual threshold is determined by the Centers for Medicare & Medicaid Services and is set as greater than or equal to $3,138 for 2015.
Why is MTM important?
MTM can help identify potential errors and gaps in your care by:
- Helping reduce the risk of medication errors - especially if you have chronic conditions, take several medications, or see multiple doctors
- Providing current information on proven medical practices to help you and your doctor determine the most effective treatment
- Helping you understand your condition and medications, so you can take an active role in managing your health.
How do you get started?
If you qualify you will automatically receive a welcome packet from us, and will be automatically enrolled in our MTM Program, unless you opt-out of enrolling in the program.
All selected customers based on the above criteria will be offered a comprehensive medication review (CMR) by a pharmacist at least annually, which will include a review of all medications including prescription, over-the-counter (OTC) medications, herbal therapies and dietary supplements. The service will be offered as an interactive person-to-person consultation with one of our Cigna-HealthSpring clinical pharmacists. Following the medication review, an individualized letter will be mailed to the customer, which will include the personal medication record of all medications discussed and a medication action plan, if applicable. Letters will also be sent to providers as necessary after the CMR is completed to offer interventions to resolve medication-related problems or other opportunities to optimize medication use. In addition, a quarterly targeted medication review will be done automatically for all eligible customers and interventions will be sent to the prescriber in a mailed letter.
Your MTM program participation may help improve your overall health and reduce your risk for serious medication reactions, hospitalization and emergency room visits. Depending on your diagnosis, it may help you improve, for example, your cholesterol levels, reduce your risk of heart attack or help to manage your blood sugar levels.
How much will this program cost?
There is no extra cost for this program. While not considered a Medicare benefit, the MTM program is part of the plan you select for coverage.
If you have questions or need additional information, please call the Cigna-HealthSpring MTM program directly toll-free at 1-800-625-9432. Appointments are available Monday through Friday 8 am to 5 pm EST. If you have any specific questions concerning health plan benefits, coverage issues, or claims, please contact us
The Medication Therapy Management (MTM) Program is a component of Cigna-HealthSpring prescription drug plans and should not be considered a Medicare benefit. MTM is neither offered nor guaranteed under our contract with the Medicare program and is not subject to the Medicare appeals process.
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