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Medication Therapy Management Program

Medication Therapy Management Program

MTM Program -2025

Quality Initiatives and Medication Therapy Management Program (MTM) 

Global Health is committed to providing the highest quality services. To this end, the Pharmacy Department has been developing initiatives to improve the quality of life of our members. Some initiatives have the objective of promoting the proper use of medications to manage different health conditions such as osteoporosis, rheumatoid arthritis, asthma, and cardiovascular diseases, among others. Also, to promote the proper management and control of diabetes, hypertension, and high cholesterol, we have initiatives aimed at improving adherence to the medications used to treat these health conditions. We also have the Medication Therapy Management Program (MTM), which is described below: 

  1. What is the Medication Therapy Management (MTM) program?

The Medication Therapy Management (MTM) program is a service whose purpose is to optimize therapeutic outcomes by improving medication use and reducing adverse effects. A trained and licensed clinical health care provider (pharmacist, nurse, or physician) will contact the participant member and your physician "if necessary" to resolve any medication-related problem and help you get better results. This program is not part of your plan benefits package. 

  1. How members are eligible for the MTM Program?

The members are selected in a quarterly basis according to clinical information and pharmacy claims. The member must meet one of the following two groups (1) and/or (2) criteria: 

1)  A) Have three chronic conditions. These chronic conditions are: 

        • Hypertension 
        • Chronic congestive heart failure (CHF) 
        • Diabetes 
        • Dyslipidemia 
        • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and chronic lung disorders 
        • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis) 
        • End-stage renal disease (ESRD) 
        • Mental health (including depression, schizophrenia, bipolar disorder, and chronic/disabling mental health conditions) 
        • Human immunodeficiency virus /acquired immunodeficiency syndrome (HIV/AIDS)
           
        • Alzheimer’s disease

B) Must be using multiple Part D medications; and the member must incur in an average expense of 1,623 in cost for eight (8) generic drugs.

2) Are at-risk beneficiaries under a Drug Management Program (DMP) 

  1. What are the services of the MTM Program?
    • Annual comprehensive review of your medications (CMR), including over-the-counter drugs, vitamins, dietary supplements, and herbal therapies. 
    • Help you understand how to take your medications and answer any questions you may have about your medications. 
    • Evaluate the risk of potential drug interactions. 
    • Ensure you are not experiencing any side effects to your medications. 
    • Advise about more cost-effective medication alternatives. 
    • Reach out to your healthcare provider when a potential medication related problem is identified. 
    • Provide information on how to manage your health condition. 
    • Quarterly targeted medication reviews (TMRs) with follow-up interventions when necessary. 
    • Provide information about the safe disposal of prescription drugs that are controlled substances, including opioids, drug take back programs, in-home disposal, and cost-effective means to safely dispose of such drugs, including the location of two (2) or more drug take back sites that are available in the community where you resides. 
    • A drug take-back site is the best way to safely dispose of medications. To find drug take back sites near you, click here and enter your location.
  1. Is there a cost for members to participate in the MTM Program?

No, the MTM Program is free to eligible members. 

  1. How can a member enroll in the MTM Program?

Global Health will identify eligible members to the MTM Program and notify them that they meet the program’s requirements through a welcome letter or a phone call. However, if you are interested in knowing if you meet the established requirements, you may contact us at Global Health Pharmacy Clinical Department at 787-945-1248 or 787-758-2500 extensions 5318,4254, 5718 and 2163. 

  1. Are members required to participate?

No, this is a voluntary program. The MTM will have a program from which you may disenroll if you wish. The member is considered enrolled in the MTM program once the member has been identified. Once in the program, members continue to be enrolled throughout the entire calendar year unless the member requests disenrollment from the program. Members may request to disenroll from the program by verbal or written request at any time. 

  1. How often will a member receive calls from the clinical health care provider?

A licensed pharmacist, nurse, or physician will contact members to conduct the comprehensive review of their medications minimum once a year and answer any questions or concerns they may have about the medications they take. Targeted medication reviews will be conducted at least quarterly. If specific or potential medication-related problems are found or the clinical health care provider needs to contact the member’s physician, follow-up calls may be scheduled more often as needed. 

  1. How can a member access the MTM program documents?

The member will receive the documents of the medication review with the information collected by the licensed health care provider (pharmacist, nurse, or physician) through mail. The mailing will be done within 14 days from the date the medication review was completed. You can access a sample of the documents that will be used in the intervention by clicking on the following links: 

  1. How does a member reach the licensed clinical health care provider (pharmacist, nurse, or physician) if they have questions about the MTM Program interventions?

Once the first intervention is made, the pharmacist, nurse, or physician will include in the medication review documents the phone numbers and the hours of service available in case you have questions or need to talk with these health care professionals.