Medication Therapy Management (MTM) is a Medicare designed program that helps you make sure that your medications are working to better manage your health and health care expenses. The MTM program is free to members who qualify and is not considered a benefit of your Part D plan.
The goals of the program are to educate members about:
- The importance of taking medications correctly;
- Identifying potentially harmful medications or combinations of medications; and
- Cost effective alternative medications.
What services does the MTM program provide?
The MTM program services include:
Comprehensive Medication Review (CMR) – A CMR is a review of your medications (including prescription, over-the-counter, herbal therapies, and dietary supplements) to identify medication-related problems. The CMR also includes an interactive, person-to-person consultation between members and a pharmacist. You will then receive a personal medication list, a summary of the review, and recommendations for you to share with your physician or healthcare practitioner.
A blank personal medication list is available for review by clicking here.
Targeted Medication Review (TMR) – A TMR is a quarterly review of your prescribed medications and a letter to your prescribers identifying specific medication-related problems with suggestions about drugs that may be safer, or work better than your current drugs. Your prescribing doctor or healthcare practitioner will decide whether to consider the suggestions. Your prescription drugs will not change unless you and your doctor or healthcare practitioner decide to change them.
Who is eligible for the MTM program?
Members are eligible for the MTM programs when they meet all of the following criteria:
- Have at least three (3) of the following chronic conditions: diabetes, chronic obstructive pulmonary disease (COPD), asthma, hypertension, dyslipidemia, chronic heart failure (CHF), osteoporosis, rheumatoid arthritis, HIV/AIDS, or depression;
- Have claims for a minimum of eight (8) different chronic/maintenance Part D covered medications; and
- Are likely to incur an average monthly drug spend equal to or greater than $354.58 for covered Part D medications during 2020.
How are members enrolled in the MTM program?
Members who qualify for the MTM program are automatically enrolled in the program. Enrolled members may opt out of specific services or the entire MTM program by calling the plan at the number shown in the contact information below.
How are members notified of enrollment in the MTM program?
You will receive a phone call and a letter from our pharmacy benefits manager, OptumRx, to schedule your comprehensive medication review (CMR) with one their pharmacists.
For more information about the MTM program, contact Member Services at 855-540-4744, TTY 711.
Hours of operation:
- October 1 – March 31: 8:00 a.m. to 8:00 p.m., seven (7) days a week.
- April 1 – September 30: 8:00 a.m. to 8:00 p.m., Monday-Friday.
Our automated phone system may answer your call during weekends and federal holidays. Messages will be returned within one (1) business day.