IEHP Medication Therapy Management (MTM) Program Through our MTM program, we can support the care you give your IEHP patients with Autism Spectrum Disorder (ASD), because we work with a pharmacist.
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How to fill out the IEHP Medication Therapy Management MTM Program online
The IEHP Medication Therapy Management (MTM) Program provides essential pharmaceutical support for patients with Autism Spectrum Disorder (ASD). This guide will assist you in accurately completing the MTM referral form online to ensure that your patients receive the best possible care.
Follow the steps to fill out the MTM referral form online.
- Click ‘Get Form’ button to obtain the referral form and open it for completion.
- Begin by checking any applicable criteria that the patient meets, such as taking four or more chronic medications, observed non-compliance, or being on medications related to severe ASD.
- Provide the patient's personal information, including their name, guardian’s name, address, city, state, date of birth (DOB), and phone number.
- Document the patient's medical history, highlighting any specifics regarding seizure events or other developmental conditions.
- List any known allergies and current medications with their strengths and directions. Include details on previous medications as well.
- Record the patient's height and weight, and calculate the BMI, providing this information accurately.
- Indicate the patient’s gender and answer health-related questions, such as smoking status, pregnancy, substance abuse history, and alcohol consumption.
- Confirm whether the patient’s immunizations are up to date. If any are missing, specify which ones were not given.
- Provide a clear reason for the referral, ensuring it outlines the specific needs of the patient.
- Fill in your name as the referring party, along with your phone number and signature. Finally, include the date of completion.
- Once finished, save the completed form, and then fax it to (909) 890-5763. For any questions, please call (909) 890-2054.
Complete the referral form online to ensure your patients receive timely support.
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What is MTM requirements?
Requirements for Medication Therapy Management (MTM) Programs: Under 423.153(d), a Part D sponsor must have established a MTM program that: Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use. Reduces the risk of adverse events.
What is the purpose of the MTM program?
The patient-centered MTM program promotes collaboration between the pharmacist, patient and prescriber to optimize safe and effective medication use. The goal of this program is to optimize therapeutic outcomes by focusing on safety, effectiveness, lower-cost alternatives and adherence.
What are the 5 components of MTM?
The model describes five core elements of MTM in the community pharmacy setting: medication therapy review (MTR), a personal medication record (PMR), a medication action plan (MAP), intervention and referral, and documentation and follow-up.
What is the essential difference between MTM and comprehensive medication management?
In MTM, the pharmacist often works apart from the health care team. In CMM, the clinical pharmacist functions as part of the team, working directly with other providers in initiating, modifying or discontinuing medications, ordering labs and documenting these changes in the EHR.
What are the qualifications for the medication therapy management MTM program?
How do I qualify for the program? You have 3 of the 5 following chronic diseases: Osteoarthritis, Hypertension, Asthma, Chronic heart failure, Schizophrenia AND. You are taking 8 or more chronic/maintenance (Part D) drugs, AND. You're likely to have annual Part D medication costs of $4,935 or more in 2023.
What are the 5 core elements of MTM services?
MTM in community pharmacy includes five core components, described on the following pages: Medication therapy review. A personal medication record. A medication action plan. Intervention and referral. Documentation and follow-up.
Who is eligible for MTM 2023?
We use criteria established by Medicare to identify eligible members. They must be filling at least eight Part D prescription drugs per month, have had an accumulated drug costs of at least $1,233.75 in the previous quarter, and have documented illnesses in at least three of these chronic conditions: Diabetes.
What is medication therapy management MTM program?
Medication Therapy Management services usually include a discussion with a pharmacist or health care provider to review your medications. These services may vary by plan. Through the MTM, you may get: A comprehensive review of your medications and the reasons why you take them.
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