The Medication Therapy Management Program (MTM) is designed to help eligible members with multiple conditions manage their drug therapy, and optimize medication use in order to improve therapeutic outcomes. This program enhances communication among physicians, healthcare professionals and members to optimize safe use of medications.
The MTM Program ensures patients take the right medications, at the right time, and in the right way. Eligible members are automatically enrolled into the program, but the member may choose not to participate. This program is offered at no cost to the member.
MTM Program Participation Criteria
Members will automatically enter the program if they meet the following three (3) criteria:
- 2020 Plans: Have incurred in expenses of Part D drug coverage, up to $1,063.75 in the last three months or $4,255.00 during the last 12 months.
2021 Plans: Have incurred in expenses of Part D drug coverage, up to $1,094 in the last three months or $4,376 during the last 12 months.
- Have three (3) or more of the following chronic conditions:
2. Bone Disease – Arthritis – Osteoporosis
3. Bone Disease – Arthritis – Rheumatoid Arthritis
4. Cardiovascular Disorders
5. Chronic Heart Failure (CHF)
6. Chronic Obstructive Pulmonary Disease (COPD)
8. End Stage Renal Disease (ESRD)
9. Mental Health – Depression
- Been using at least eight (8) chronic/maintenance drugs covered under Medicare Part D.
Services and Materials
Members enrolled in the MTM program receive:
- Welcome letter (by mail) explaining the program in detail.
- Phone call to member or caregiver for Comprehensive Medication Review (CMR) offer.
- Annual comprehensive medication review (CMR) is conducted to identify potential drug therapy problems and create an action plan to resolve them. The phone call is made directly to the member or member’s authorized representative by a nurse or pharmacist. The phone call make take 20 to 30 minutes to complete.
- Follow-up interventions by a qualified health professional, including quarterly Targeted Medications Reviews (TMR) such as monitoring of medication utilization.
- Consultations and interventions with prescribing physician to optimize drug therapy and resolve any medication related issues.
- Member will receive, within 14 days after the interview, a summary of the interview that will include the updated patient medication list and the action plan to be taken regarding the member’s drug therapy.
Download a copy of the Personal Medication List:
|Personal Medication List||Download|
For more information, contact us at 1-844-212-9858 (Toll free), 711 TTY, Monday through Sunday from 8:00 a.m. to 8:00 p.m.