Medication Therapy Management

If you are a Medicare Prescription Drug Plan member and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by our Health Plan at no additional cost. This program helps you and your doctor make sure that your medications are appropriate. It also helps us identify and reduce possible medication problems. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit.

Eligibility

To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

To qualify for the MTM program, you must:

1. Be an At-Risk Beneficiary as defined by your provider OR 
2. Meet ALL of the following criterion (a, b, and c): 
   1. Have 3 or more of the following conditions or diseases: 
      • Bone Disease - Arthritis - Osteoporosis
      • Chronic Heart Failure (CHF) 
      • Diabetes 
      • Dyslipidemia
      • Hypertension
      • Respiratory Disease - Asthma 
      • Respiratory Disease - Chronic Obstructive Pulmonary Disease (COPD) 
   2. Take at least 8 covered Part D medications 
   3. Are likely to have medication costs of covered Part D medications greater than $5,330 per year 

Clinical Review of Medications

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

• Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, your caregiver, and/or your doctor if we detect a potential problem.

• Comprehensive Medication Review (CMR): at least once per year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. This review, or CMR, is provided to you confidentially via telephone by a licensed healthcare professional. The CMR may also be provided in person or via telehealth at your provider’s office, pharmacy, or long-term care facility. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider. These services are provided on the behalf of our Health Plan. This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:

  • Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications. 

  • Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

Contact Us

For more information on the MTM program, please call our Medicare Customer Care Advocates at  1-877-883-9577 (TTY 711), available Monday – Friday from 8 a.m - 8 p.m. ET. From Oct. 1 to Mar. 31, representatives will be available seven days a week from 8 a.m. - 8 p.m. ET.