Medication Therapy Management

Many seniors have signed up for the Medicare D plan to help minimize the out of pocket cost for prescription medications. This is very good. But, many seniors are unaware of the MTM (Medication Therapy Management) component of ALL Medicare D Plans. This is an important benefit because you can save money on medications. If your medications are not managed properly, the end result can be devastating.

Exactly what is MTM? It is the process where a health professional looks at all of the medications that you are taking and tries to make sure that all the medications are working together to solve your health problems

Another important reason to check on your medications is to make sure that the medications that you are taking together are not creating further health problems for you due to duplications, contraindications, etc.

There is much more to medication therapy management than getting counseling on a particular medication at your pharmacy. MTM is a much more in depth study that is done to root out current and future medication problems. The true purpose of MTM is to be pro-active in maintaining good health while avoiding medication problems that may become serious or life threatening.

Let’s take for example Joe Story, who came into Lincourt Pharmacy with all of his medications seeking some assistance. The Lincourt pharmacist performed a complete medication check-up and discovered that although Mr. Story was prescribed an allergy medication, he actually received a heart medication due to the similarities between the names of the two medications.

The Lincourt pharmacist intervened and communicated the error to the dispensing pharmacy. The issue was resolved and the patient avoided complications that could have resulted from the continued use of the incorrect medication.

Obviously, this is more than mandatory pharmacy counseling and you, as a Medicare D Plan recipient should be taking full advantage of these services.

It is recommended that you encourage your plan to allow your local pharmacist to participate in their MTM plan. You can’t possibly receive the care required by talking to someone on a 1-800 line.

Here is another matter of importance to you as a Medicare D recipient, never accept no for an answer. The Medicare D Plan allows for appeals and exceptions to every rule they make.

So, if your medication is not covered, call the plan and request an exception. Of course, you will need the help of your physician and your pharmacist to make this happen. Be aware, you will only get one exception per appeal.

In other words, the plan will not exempt a non-formulary medication plus exempt a higher co-pay. Just remember, this is an insurance company and getting them to act on your behalf will take a little time.

Last, but not least, be aware of Medicare D Plans that offer everything including no “doughnut hole”. Because if it’s too good to be true, it probably is.

For example, let’s say all of your generic drugs are covered at $5.00 a prescription. That’s great! But, beware that any brand name medication can be heavily penalized with a $35 to $50 or more co-pay.

Also, don’t forget to get prior approvals and if you see a rejection due to a formulary change, request an exception.

The best plans are those that have a willingness to work with your health care professionals (doctors, pharmacists, etc.) to solve your health issue with minimal obstacles.

Remember, always ask questions.