Medication Therapy Management

December 2013

Criteria

A single medication therapy management follow-up encounter may be authorized if:

Recipient has been diagnosed with a new chronic condition since the last encounter that requires treatment with 2 or more new medications OR
Recipient’s current condition(s) has changed or worsened requiring a change or addition of 3 or more medications AND
Patient has eight or more paid encounters in the last 365 days
Patient has communicated to the pharmacist significant problems with the new drug regimen and intervention is necessary to prevent possible hospitalization or emergency room visit
Patient has a history of medication compliance
Patient's past MTM encounters have resulted in documented positive outcomes

Pharmacy unit must receive (Fax # 651-431-7426)

Patient MHCP ID number
Patient’s new diagnosis or description of the changes in the patient’s condition(s)
List of new medications since last encounter
List of changed medications since last encounter
List of new problems presented by the new drug regimen
Expected outcomes of encounter
Documentation of all encounters in last 365 days
Date of next MTM encounter
Treating pharmacist name and provider number
Clinic or pharmacy “pay to” provider number
Treating pharmacist phone number

MHCP Provider Call Center 651-431-2700 or 800-366-5411