Medication Therapy Management Services

Effective July 1, 2022, members may receive face-to-face Medication Therapy Management (MTM) services provided by a Medicaid enrolled pharmacist in an outpatient setting.

Pharmacist Eligibility

• Is licensed as a pharmacist in the state of Utah
• Has enrolled as a provider with Utah Medicaid using an individual NPI number

Patient Eligibility

• Medicaid-enrolled adult and pediatric patients
• Is in an outpatient setting (not inpatient or a long term care facility)
• Is not eligible for Medicare Part D
• Is taking at least 3 medications to treat or prevent at least 1 chronic disease

Documentation Requirements

• Patient information must include:
  • Patient’s full, legal name
  • Date of birth
  • Gender
  • Telephone number
  • Address 
  • Current and past medical conditions
  • Allergies
  • Primary physician and contact information
  • Date of appointment
  • Time spent with the patient
  • Medication list that includes all prescription and non-prescription medications, including vitamins, supplements, and herbal products
  • Overall evaluation of the patient’s medication regimen, as well as any specific concerns or drug-related problems outlined in the Utah Medicaid Medication Therapy Management Program Encounter Guidance
  • Written plan (Patient/Provider MTM Summary Reports), including goals and actions, needed to resolve issues of current drug therapy, which will be provided to the patient and applicable provider within two business days of the encounter
  • Evaluation of success in meeting goals of medication treatment plan
  • Coordination, follow-up, and integration activities within the broader healthcare management services being provided to the patient
  • Providers must be contacted by phone for all interventions that require immediate attention, and all written and verbal communication must be documented in the patient’s MTM record

• MTM Documentation shall be maintained for a period of five years

Requirements for Covered Services 

• The MTM encounter is conducted one-on-one with the patient or caregiver (e.g., caretaker relative, legal guardian, power of attorney, licensed health professional)
• MTM encounters must be conducted face-to-face

Encounter Limits

• One initial encounter and three follow-up encounters will be covered per Medicaid patient in a 365-day period