Medication Therapy Management

If you qualify for the Medication Therapy Management (MTM) Program you will have the option to speak with a clinical pharmacist or other qualified healthcare provider about your medications and medical conditions.

Quick Facts about your MTM 

MTM was created with YOU in mind. This is a free service that you will automatically be enrolled in if you qualify. Your MTM can be completed on the telephone from the comfort of your own home and you can take your time asking questions about your medications and medical conditions. Once enrolled you can opt-out of the MTM program at any time.

Qualifying for the MTM Program

For 2024, in order to qualify for the MTM program, you must:

1. Have at least three of the following conditions: 
   • Asthma 
     
   • Bipolar Disorder
     
   • Chronic Heart Failure (CHF) 
     
   • Chronic Obstructive Pulmonary Disease (COPD) 
   • Diabetes 
   • End-Stage Renal Disease (ESRD) 
   • Hypertension 
   • Multiple Sclerosis
     
2. Take at least eight or more prescription maintenance medications.
   
3. Have spent one-fourth of the specified annual cost threshold ($5,330 for 2024) in the previous three months ($1,332.50). 
   

Once you qualify you will receive a welcome packet that includes instructions on how to complete your MTM appointment. You will also receive calls throughout the year to remind you to schedule your MTM appointment and/or complete it with the pharmacist at that time. 

How Your MTM Works

First, you’ll have a call with a pharmacist or other health care professional to complete a comprehensive medication review (CMR). This call usually takes around 20 minutes. During this call you will: 

• Review your medication list, including prescription medication and over-the-counter medications
• Review your prescription drug costs
• Have the chance to ask questions about your medications and/or medical conditions
• Discuss side effects you may experience from your medication 

After your call you will receive a written CMR summary of your MTM appointment in the mail. This summary will include the medication list you reviewed during the appointment and a recommended to-do list with counseling points and next steps for you to take. Your CMR summary will include information like: 

• Tips for remembering to take your medications 
• How to prevent side effects or when to report side effects to your prescriber 
• Ideas on changes to possibly lower costs
• Suggestions to improve your health through preventative measures 

Having this information can help you see your overall health picture. It can also help you and your doctor make any changes. 

Using Your CMR Summary 

Keeping your care team informed on your prescription drugs is one way to achieve whole care. Your MTM summary is a tool to use on a regular basis. You can bring it to: 

• Doctor visits
  
• Your pharmacist 
  
• Other health care provider visits
  
• The hospital or emergency room
  

You can also use it when you and your doctor review drugs on your Medicare D-SNP Diamond and Ruby Drug List.

View CMR Summary Example

Have Questions? 

If you have questions about your MTM Program or your prescription benefits, please call Member Services at 1-844-339-7684 (TTY 711).