Medication Therapy Management

The Medication Therapy Management (MTM) program reviews the medicines you take to make sure that they're safe, work well and fit your lifestyle. This program is offered at no additional cost to eligible members. This service is not considered a benefit.

The goal is to help you get the best results from your medicines, at the lowest possible price. The MTM program is right for you if you need answers to questions below:

  • Why am I taking these medicines?
  • Do over-the-counter products interact with my prescriptions?
  • Can I save money on my prescriptions?

MTM can help you and your doctor make sure that your medicines are the best choice for you.

Who's eligible for MTM?

You're automatically enrolled in the MTM program if you:

2020

Have 3 or more of the following conditions:

  • Chronic Heart Failure
  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Rheumatoid arthritis
AND
Take 8 or more prescription medications covered by Medicare Part D.
AND
Expect to spend more than $4,255 in 2020 on prescription medicines covered by Medicare Part D.
2021

Have 3 or more of the following conditions:

  • Chronic Heart Failure
  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Rheumatoid arthritis
     
AND
Take 8 or more prescription medications covered by Medicare Part D.
AND
Expect to spend more than $4,376 in 2021 on prescription medicines covered by Medicare Part D.

What you can expect

The MTM program is a two-part program. Reviews can be done over the phone, whenever it's convenient for you. In some cases, you may have an in-person review.

1. Comprehensive Medication Review (CMR)

This personalized review lets you talk one-on-one with an MTM pharmacist.

To get ready for your review make a list of all the medicines you take. Write down all over-the-counter medicines or supplements. Include how much you take each day and how often you take them. Even over-the-counter medicines or supplements. The pharmacist will review your list and talk about it with you. This usually takes about 30 minutes.

After your review, you'll get a complete list of your medicines, a personal medication list, and an action plan that you can bring with you to your next doctor's visit.

2. Targeted Medication Review (TMR)

Every few months, the program reviews your prescription claims to make sure there are no issues that need attention. A pharmacist will look for ways to improve your medicine therapy. If the review identifies any issues, he or she will contact you and your doctor.

Getting started

If you're eligible for MTM, you're automatically enrolled. You'll get a letter or phone call letting you know how to schedule an appointment or opt out of the program.

Opting out

Medicare requires us to automatically enroll you if you're eligible. But, this service is voluntary – you're not required to participate. You may also choose to take part in only certain services you find valuable. You can cancel your enrollment or choose to reenroll at any time during the calendar year. Your prescription drug coverage will not change if you take part in the MTM program or not. For assistance, Contact Us.

For more information

If you'd like to know more, Contact Us.

The MTM Program is a service offered to eligible members at no extra cost; this service is not considered a benefit.