Medication Therapy Management

The Medication Therapy Management (MTM) program helps you get the greatest health benefit from your medications by: 

• Avoiding medication related problems such as side effects and interactions 
• Better managing your medications 
• Optimizing the benefits of medication therapies 

Who qualifies for the MTM program? 

We will automatically enroll you in the Medication Therapy Management Program at no cost to you if all three (3) conditions apply: 

• You take eight or more Medicare Part D covered maintenance medications, and 
• You have three or more of these long-term health conditions: 
  
  • Asthma 
  • COPD 
  • Diabetes 
  • Depression 
  • Osteoporosis 
  • Chronic Heart Failure 
  • Cardiovascular Disorders such as High Blood Pressure, High Cholesterol, or Coronary Artery Disease  
• You reach $4,935 in yearly prescription medication costs paid by you and the plan. 

Your participation is voluntary, and does not affect your coverage. This program is free of charge and is open only to those who are invited to participate. The MTM program is not considered a benefit for all members. 

What services are included in the Medication Therapy Management Program (MTM Program)? 

• The MTM program provides you with:  
• An annual Comprehensive Medication Review (CMR), and a 
• Quarterly Targeted Medication Review (TMR) 

Comprehensive Medication Review

A CMR is a one-on-one discussion with a trusted pharmacist, usually over the telephone, to review all of your medications including prescription medications, over-the-counter (OTC) medicines, herbal therapies and dietary supplements and vitamins. 

A Comprehensive Medication Review with one of our trusted pharmacists will: 

• Help you to better understand your medications. 
• Help you to better manage your health conditions. 
• Help you to avoid medication related problems. 
• Answer any questions you may have about how to take your medications, what to watch for, or how to save on costs. 

The pharmacist will offer ways to manage your conditions with the medications you take. If more information is needed, the pharmacist may contact your prescribing doctor. A CMR review takes about 20 minutes and usually offered once each year — if you qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List of the medications you discussed during your CMR. 

You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit. 

Here is a blank copy of the Personal Medication List for tracking your prescriptions. 

Targeted Medication Review (TMR) 

Once a quarter we will review your medications to ensure there are no safety concerns, missed opportunities, or other issues. Any recommendations will be sent to your prescriber. As always, your prescribing doctor will decide whether to consider our recommendation. Your prescription medications will not change unless you and your doctor decide to change them.  

How will I know if I qualify for the Medication Therapy Management Program (MTM Program)? 

We will automatically enroll you and send you a welcome letter if you are eligible for the program. Along with the welcome letter, you will be contacted by an MTM Outreach Specialist to schedule your one-on-one medication review. One of our trusted pharmacists will conduct your comprehensive medication review by telephone for your convenience. 

Why is a review with a pharmacist important? 

Your health is our top priority. The medication review is a service to use in addition to the care you receive from your doctor or pharmacists. The aim of the MTM program is to work with you and your doctor to achieve and maintain the safest and most effective medication therapy for you. For that reason, a pharmacist will: 

• Discuss how your prescription drugs and OTC medications may affect each other. 
• Identify any prescription drugs and OTC medications that may cause side effects, and offer suggestions to help. 
• Help you get the most benefit from all of your prescription drugs and OTC medications. 
• Review opportunities to help you reduce your prescription drug costs. 

How do I benefit from talking with a pharmacist? 

Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely. 

This also provides the pharmacist an opportunity to look for ways to help you save money on your out-of-pocket prescription drug costs. 

You also benefit by having a Personal Medication List to keep and share with your doctors and health care providers. 

How will the MTM program affect my plan coverage? 

The MTM program is not considered part of your plan benefits that you pay for. 

Your participation is voluntary and does not affect your coverage in any way. This program is free of charge and is open only to those who are eligible to participate. 

How can I get more information about the Medication Therapy Management Program (MTM Program)? 

Please contact us if you would like to schedule your annual comprehensive medication review or if you would like additional information about our MTM program. Our toll-free number is 1-800-240-3851 (TTY 711). Our team is available from 8 a.m. - 8 p.m., 7 days a week. 

Last updated: 03/2024