Enhanced Medication Therapy Management (EMTM) Pilot

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What is EMTM?

EMTM is a pilot program sponsored by the Centers for Medicare and Medicaid Services (CMS). This pilot builds on the basics of medication therapy management and incorporates innovative solutions that may better help patients meet health care goals.

How does this enhanced service differ from other medication management programs?

  • It tests whether providing more regulatory flexibility and incorporating innovative programs will improve patient outcomes.
  • It combines claims information from Medicare Parts A and B as well as pharmacy claims from Part D which provides consolidated data that helps us better identify patient needs.
  • After identifying at-risk patients, we out-reach to them with one-on-one telephonic care from specially-trained pharmacists and support staff.

Why should health care professionals participate with EMTM?

By working together on this pilot, pharmacists and providers can improve clinical outcomes, decrease costs and provide a team-based approach to outpatient care.

This program continues for five years through 2021. During that time we look forward to working with prescribers and pharmacists for input and participation.

What is MedicareBlue Rx (PDP)?

  • MedicareBlue Rx is offered through the Northern Plains Alliance, a group of six Blue Cross and Blue Shield plans from seven states. It is one of only five plans offering EMTM services in Medicare Region 25 (IA, MN, MT, NE, ND, SD, and WY).
  • MedicareBlue Rx members enrolled in the Standard Plan are participating in the CMS Enhanced MTM pilot which began January 1, 2017.

For more information contact us