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Medicare Part D Medication Therapy Management (MTM) Programs

Beginning January 2013, if patients are enrolled in a Part D MTM program, they will receive a printed standardized summary, Form CMS-10396, as a reference about their CMR. This summary will include a Cover Letter, Medication Action Plan, and Personal Medication List. Patients are encouraged to share these documents with their Physicians and other healthcare providers at their regular visits and request updates as needed.

For more information and sample forms please visit:

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