Medication Therapy Management (MTM)

Better therapeutic outcomes for members with multiple conditions.

medication thearpy

Focused on Improvement

Here's what you
should know

Our Medication Therapy Management Program (MTMP) is focused on improving therapeutic outcomes for Medicare Part D members. To qualify for MTMP, a member must meet all of the following criteria:

  • Members must have filled eight or more chronic Part D medications; and
  • Members must have at least three of the following ten chronic conditions
    • High Blood Pressure
    • High Cholesterol
    • Congestive Heart Failure (CHF)
    • Diabetes
    • Depression
    • Osteoporosis
    • Rheumatoid Arthritis
    • Asthma
    • COPD
    • HIV
  • Members must be likely to incur annual costs of $4,935 for all covered chronic Part D medications.

OR

  • Are in a Drug Management Program to help better manage and safely use medications such as opioids and benzodiazepines

Do you meet all of the criteria above? Learn more about how to manage the various medications you need to stay healthy.

The success of our MTMP is built upon our proven experience using a wide range of services designed to help members with multiple conditions by:

  • Ensuring they take their medications correctly
  • Improving medication adherence
  • Detecting potentially harmful medication uses or combinations of medications
  • Educating members and health care providers

Our programs are evidence-based and can integrate both pharmacy and medical data, when available, and are built upon multiple measures that demonstrate positive clinical outcomes for members like you. Pharmacists, physicians and PhDs develop, manage and evaluate the programs for effectiveness.

One-on-one consultations between our clinicians and members are also an important part of our MTMP. Such consultations ensure that members are taking their medications as prescribed by their health care provider.

What You Can Expect

Comprehensive Medication Review (CMR)

The Centers for Medicare & Medicaid Services (CMS) requires all Part D sponsors to offer an interactive, person-to-person comprehensive medication review (CMR) to all MTM-eligible members as part of MTMP. If you meet the criteria outlined above, you will receive an MTMP Enrollment Mailer or phone call offering our CMR services. A CMR is a review of a member’s medications (including prescription, over-the-counter (OTC), herbal therapies and dietary supplements), which is intended to aid in assessing medication therapy as well as optimizing outcomes. Also, MTMP-eligible members will be included in quarterly targeted medication review (TMR) programs that assess medication profiles for duplicate therapy or drug-disease interaction in which members’ prescribers may receive a member-specific report.

The CMR includes three components:

  1. Review of medications to assess medication use and identify medication-related problems. This may be conducted person-to-person or “behind the scenes” by a qualified provider and/or using computerized, clinical algorithms.
  2. An interactive, person-to-person consultation performed by a qualified provider at least annually to all MTM-eligible members.

An individualized, written summary of the consultation for the member, including but not limited to, a medication list, reconciled medication list, and recommended to-do list for monitoring, education, or self-management.

Do you have unused expired medications and are looking for a safe way to dispose of them?

 Before you throw them away, here are some things you should know.

Here is how to safely dispose of unused or expired medications before they do harm:

For safety reasons, dispose of unused medications as soon as possible. Here are a few tips for safe disposal:

  • Find a nearby pharmacy or other local resource with a medication take back service.
    • The US Drug Enforcement Administration (DEA) allows unused prescription medications to be returned to pharmacies or other authorized sites. You can locate participating locations at: usdoj.gov/pubdispsearch/ 
    • Community take back sites are the preferred method of disposing of unused controlled substances.
    • Additional drug disposal information can be found on the DEA website at: www.deatakeback.com.
  • If you cannot get to a drug take back location promptly, or there is none near you:
    • Mix the unused supply with an undesirable substance such as dirt or coffee grounds.
    • Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag, then place the sealed container in your trash.
    • Make sure to conceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off to protect your privacy.
    • Place both the sealed container with the mixture and the empty drug containers in the trash.
    • Only flush approved unused or expired medications down the toilet only if indicated on the label, patient information, or no other disposal options are available.

More information on the safe disposal of medications can be found on the United States Department of Health and Human Services website: hhs.gov/opioids/prevention/safely-dispose-drugs/ 

Contact OptumRx or your health plan at the number listed on the back of your ID card for more information about our MTMP.  If you have any questions about the MTM program, please call the MTM Department at 1-866-352-5305 (TTY users dial 711), Monday – Friday, 8 am to 8 pm CST.

These programs are provided at no additional cost as part of your coverage and are not considered a benefit

Page Last Updated On: December 28, 2022
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Tom Cunniffe

Director of Operations 

Tom Cunniffe comes to eternalHealth with over 20 years of healthcare operations’ experience, having held leadership positions in Call Center, Enrollment, Credentialing, UAT and Reimbursement teams. Tom has worked with Medicaid, Commercial and Medicare lines of business and has consistently built teams who are metrics driven with proven successful outcomes. Making sure our business strives for an efficient, best-in-class customer experience is at the center of Tom’s philosophy.

Tom has a bachelor’s degree from Fordham University and a master’s in business administration from University of Massachusetts at Amherst.

Tom Lawless

Chief Financial Officer

Tom Lawless has spent the past 20+ years building, sustaining, and growing new healthcare-related programs that balance fiscal responsibility & prudence with creativity & innovation, focusing on models of care that are novel, person-centered, and improve the social welfare of those who are served. He is very excited to continue doing so in his role as the Chief Financial Officer of eternalHealth.

Tom comes to eternalHealth from a not-for-profit, member-centric, health insurance cooperative. He helped the company continuously strive toward its dual goals of thriving financially, while keeping members at the very epicenter of its mission and service model. While there, Tom also spearheaded the creation of a brand new private, charitable foundation, which will be meaningfully giving back to those in need in the surrounding communities for years to come. Previously, Tom worked in the finance department of a successful hospice that provided high-quality care to persons experiencing their unique and poignant end-of-life journeys, assuring that the appropriate financing was always available. Tom’s career began as a civil servant in the Wisconsin Medicaid program, where he helped to create a program that expanded the institutional entitlement to care into home and community-based settings. Starting with only a blueprint in hand, the program now serves more than 57,000 frail elders and disabled adults and is considered a national model. Growing into a senior leadership role, Tom was a key architect of an innovative financing model, through which the public and private sectors successfully collaborated to better the lives of persons in great need.

Tom holds undergraduate and graduate degrees from the University of Chicago, with additional graduate work in economics completed at the University Wisconsin-Madison.

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