What beneficiaries will qualify for MTMP?
Section §423.153(d) states that a Part D sponsor must have established a MTMP that — • Is designed to ensure that covered Part D drugs prescribed to targeted beneficiaries are appropriately used to optimize therapeutic outcomes through improved medication use • Is designed to reduce the risk of adverse events, including adverse drug interactions, for targeted beneficiaries; • May be furnished by a pharmacist or other qualified provider; and • May distinguish between services in ambulatory and institutional settings. Targeted beneficiaries as enrollees in the plan who — • Have multiple chronic diseases; • Are taking multiple Part D drugs; and • Are likely to incur annual costs for covered Part D drugs that exceed a predetermined level as specified by the Secretary. This was later defined as $4,000. CMS envisions that plans will use system edits – computerized notices that appear on the pharmacists’ computer when a beneficiary fills a prescription – as the most common method for identify
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