MEDICARE PART D
PRIME MEDICATION THERAPY MANAGEMENT PROGRAM
Background. Prime Therapeutics (Prime) is committed to optimizing therapeutic outcomes through improved medication use, as well as reducing the risk of adverse drug events. As such, Prime has developed an outpatient pharmacy medication therapy management program for the purpose of direct interaction with patients by pharmacists. Pharmacies must be contracted to provide MTM services to be eligible to receive payment for performing MTM interventions.
Dispensed Drug Service. Upon completion of an Intervention where the interacting drug is dispensed as originally prescribed (and a message was sent to the pharmacy warning of a MTM interaction), the Pharmacy may be eligible for MTMP online reimbursement based on the level of intervention. Only one reimbursement will be provided per drug per member.
MTM Online Fee Processing Instructions
Nondispensed Prescription Drug Service. If in the professional judgment of the pharmacist the medication should not be dispensed to the MTM Covered Person as originally prescribed, Pharmacy may be eligible for one time MTMP manual reimbursement based on the level of intervention. The Pharmacy will submit a fax form to Prime requesting payment to the Pharmacy for the MTMP service. Only one reimbursement will be provided per drug per member.
MTM Manual Fee Processing Instructions