The growing cost of medical & healthcare is one of the nation’s most pressing social, medical & economic challenges. Millions of Americans struggle to afford the medications they need, frequently foregoing them due to price. The high cost of prescription drugs is a daunting challenge for Americans of all ages.

Medication Therapy Management (MTM) program intends to reduce the cost of prescription drugs while improving health outcomes. This is done trying to identify medication related problems in a patients drug profile and providing appropriate intervention where required. MTM uses Evidence Based Medicine and promotes best practices among prescribers and also increase patients awareness about the disease, reducing drug costs and increasing patient adherence to therapy and drug regimens.

CF Health offers a turn-key MTM solution for all PDP’s at affordable cost while maintaining quality.

Objective of the Assignment

• To provide MTM services for the Clients as per the requirement of 2010 call letter and subsequent CMS guidance.
• To help prepare reporting as per CMS guidelines.
• To provide a Therapeutic Interchange program to reduce drug cost and improve formulary adherence.
• To provide Coverage Determination as per the plans benefit design and formularies.
• To handle Redetermination Appeals, if required, as per CMS requirements under the ambit of a board certified physician and Medicare specialist.

Scope of the Assignment

• The MTM program covers 3 operational areas:
• Identification of MTM eligibility as per CMS rules & criteria selected by the clients.
• Providing of MTM services – Annual Comprehensive Review, targeted quarterly medication review, provider interventions & patient communication.
• Reporting MTM services will only be provided to MTM eligible members as per CMS criteria.

Should you need to know more about our MTM / TI program, we request you to send us mail at
mtm-ti@cf-health.com