Part D medication review
A sponsor-selected beneficiary receives a comprehensive review, medication list, and action plan from a contracted qualified provider.
Contact us FOR YOUR PRACTICE
Independent pharmacies and pharmacy partners
Separate plan-sponsored medication review from support provided to a treating practice and from ordinary pharmacy operations.
RELEVANT PATHWAYS
What can our pharmacy run and get paid for?
Start with your Part D sponsor or contractor’s MTM arrangement. A pharmacy may also explore an actual contracted support role with an eligible treating practice. Owning a pharmacy or employing a pharmacist does not create independent Part B RPM or RTM billing eligibility.
MTM · Medication Therapy Management
Sponsor-selected beneficiaries and a contracted medication-review program.
Patient example, requirements, and billingRTM · Remote Therapeutic Monitoring
A separately verified support arrangement with a real treating and billing professional, not a pharmacy-only claim.
Patient example, requirements, and billingCheck this before choosing a programA refill reminder, dispensing encounter, or generic medication app is not automatically RTM or a completed MTM service. The contracted MTM illustration below is not a national rate card.
EXAMPLES FOR YOUR SETTING
Start with a real need in your practice.
These scenarios show what to evaluate, rather than automatically assign a program or approve reimbursement.
Embedded clinical pharmacist
An eligible treating practice may assess an appropriate support role, with scope, supervision, code, and contract review.
Front-desk needs
Interactly can support agreed scheduling and message workflows. Clinical medication questions go to qualified staff.
ONE ILLUSTRATIVE MTM JOURNEY
See the patient, practitioner, and support roles.
Meet Luis: his Part D plan selects him for MTM, and a contracted pharmacy arranges a medication review.
Verify selection
Before the review- Patient / caregiver
- Receives a plan-based invitation and chooses whether to participate.
- Treating practice
- Confirms sponsor eligibility and the provider’s contract.
- PrimeVital’s agreed role
- Can help organize agreed outreach and administrative routing.
- What gets recorded
- Sponsor selection, provider arrangement, service protocol, and payment terms.
The sample goal
Give Luis a clear medication list and an action plan for medicine-related questions.
YOUR INVOLVEMENT
Agree on responsibilities before the first patient starts.
Your organization
The qualified medication-review provider performs the review and routes clinical recommendations to prescribers. The pharmacy verifies sponsor eligibility, contract, protocol, and records.
PrimeVital’s agreed support
Interactly can provide agreed front-desk services. Medication-program outreach, records support, or care-team collaboration would be scoped with the pharmacy and its actual sponsor or treating-practice arrangement.
Service hours, professional qualifications, technology, integrations, records access, and fees are confirmed in the engagement. Front-desk automation handles agreed administrative tasks; clinical judgment and claims remain with the responsible qualified professionals.
WHAT YOU NEED TO DO
A practical launch checklist.
- Verify sponsor selection and the actual MTM provider contract.
- Confirm who performs the review, required materials, follow-up, and payment.
- For a practice collaboration, identify the responsible clinician, clinical need, scope, supervision, and documentation.
- Keep dispensing, plan MTM, clinical support, and administrative work distinct.
- Agree on record access and secure prescriber handoffs.
PAYMENT & FINANCIAL PICTURE
Who gets paid, and what does the practice spend?
For Part D MTM, payment comes from the sponsor or authorized contractor under the provider arrangement. For clinical support, the eligible practitioner bills only qualifying services and compensates support through a contract. Neither is an automatic Part B pharmacy claim.
Illustrative MTM model
These starting figures are hypothetical. They are not Medicare rates, a PrimeVital quote, or a payment forecast. Replace them with your verified contract, service mix, and cost assumptions.
Service, device, and practice costs
Illustrative agreement: fees apply to enrolled patients, even if a service does not qualify for payment.
Leave at zero if already included in the service fee. Avoid counting it twice.
Shown separately from recurring operating costs.
35 of 50 patients meet the assumed service requirements.
Collections
$3,500
Operating costs
$2,150
Contribution
$1,350
$1,750 service fees + $0 additional device costs + $400 practice costs.
Contribution is before other overhead and taxes. Actual billing uses service-level evidence and rules; this simplified model does not select codes, approve eligibility, or guarantee outcomes. Patient cost sharing and QMB protections must be checked separately.
BENEFITS TO TRACK
Choose a baseline and a review date.
Agree on the measures that matter to your patients and team.
- Completed eligible medication reviews
- Medication issues resolved with prescribers
- Patient understanding
- Contract payments and delivery costs
Sources and scope
Reviewed October 7, 2026. Practice type alone does not establish clinical eligibility or payment. Detailed program pages maintain the code references; use the patient’s actual payer, professional, setting, and date of service.
YOUR PRACTICE, YOUR PATIENTS
Bring us the workflow you want to improve.
Share your practice type, patient group, payer mix, and current team. We can map the care pathway, available support, launch gaps, and assumptions to verify.
DESIGN A PRACTICAL STARTING POINT
Tell us where the workflow is breaking. We’ll show you where to begin.
Send us a message
Continue on your phoneScan to open a pre-addressed email draft.Email contact@theprimevital.com