Medication therapy management

If you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.

The MTM program is a service offered at no additional cost to you. These services are provided in line with CMS guidelines and are not considered a benefit.

How do I participate in this program?

You'll be automatically enrolled in this program if you meet the three requirements below.

1. Have at least three of the following conditions or diseases:
   • Alzheimer's Disease
   • Chronic heart failure (CHF)
   • Diabetes
   • Dyslipidemia
   • Hypertension
   • Respiratory disease-asthma
   • Respiratory disease-chronic obstructive pulmonary disease (COPD)
2. Take at least eight covered Medicare Part D medications.
3. Are likely to have greater than $5,330 per year in covered Medicare Part D medication costs.

You'll be automatically enrolled in this program if you're in a drug management program that defines a specific drug dose, pharmacy or doctor.

What services does the MTM program offer?

To help reduce the risk of possible problems, our MTM program offers two types of clinical review:

• Targeted medication review: At least every three months, we'll review all of your prescription medications. If we find a concern relating to safety or cost, we may contact your doctor.
• Comprehensive medication review (CMR): To help you safely use medications and ensure they're working to improve your health, we offer a free annual review by a pharmacist or other health professional. This review can take place at your provider's office, pharmacy, or long-term care facility. It takes about 20 minutes. You'll receive a written summary of the CMR to share with your doctors. The summary includes:
  • Medication Action Plan (MAP): Your MAP includes steps you can take to get the most from your medications. Blank versions are available in English (PDF) and Spanish (PDF).
  • Personal Medication List: Your PML helps you keep track of and properly use your medications. Blank versions are available in English (PDF) and Spanish (PDF).
• The CMR is offered through a partnership with the Navitus Clinical Engagement Center.

Next steps

If you're eligible, we'll send you a letter to let you know you've been automatically enrolled. it will include information about the MTM program, including contact information and instructions to opt out if you choose. To get more information or opt out, call Member Services at 1-877-232-7566 (TTY: 711).