Medication therapy management
Reduce risks and costs when you take multiple medications
If you take multiple medications, you’re at increased risk for errors that can result in serious complications such as heart attacks, falls, blood clots and kidney failure.
Our Medication Therapy Management (MTM) program aims to prevent such errors. The program is a collaboration between you, your pharmacist and doctors to ensure you take medications safely while achieving the best possible outcome.
While MTM services are free for eligible members (defined below) with Medicare Part D prescription drug coverage, MTM is not a plan benefit.
Benefits of MTM include:
- Improved adherence: We’ll help you safely take medications as prescribed.
- Improved safety: MTM can help you avoid dangerous side effects and duplication of medications.
- Lower costs: The program has reduced members’ direct pharmacy costs by an average of 16 percent and indirect medical costs by 21 percent.
Who is eligible for the Medication Therapy Management program?
You’re eligible for MTM if you:
- Use eight or more medications
- Spend more than $5,330 in 2024
- Have at least three qualifying medical conditions from the list below:
- Acid (Reflux/Ulcers), Alzheimer’s Disease, Anemia, Arthritis, Benign Essential Tremor, Benign Prostatic Hyperplasia, Cardiovascular Disorders, Cerebrovascular Disease, Chronic Heart Failure, Chronic non cancer pain, Crohn’s Disease, COPD, Dementia, Diabetes, Dyslipidemia, End-Stage Renal Disease, Hepatitis C, Incontinence, Insomnia, Multiple Sclerosis, Neurological Disorders, Osteoporosis, Parkinson’s Disease, Plaque Psoriasis
- are identified as an at-risk beneficiary using clinical guidelines for misuse or abuse of frequently abused drugs
If you’re eligible, we’ll contact you to explain the program and its potential benefits. A pharmacy team member will contact you to answer your questions and set up an appointment with one of our MTM pharmacists.
You will not need to change doctors or pharmacies to enroll in the MTM program.
How does Medication Therapy Management work?
Once you’re enrolled in MTM, a pharmacist will call you to conduct a Comprehensive Medication Review (CMR). During this review, the pharmacist will:
- Discuss your medications and answer questions
- Identify possible drug interactions
- Highlight potential ways to reduce your drug costs
- Determine if any medications need to be adjusted for safety or to improve your health
The pharmacist will work with your doctors to make any necessary medication changes.
After completing the review, within 14 days you’ll receive a letter containing:
- Your MTM pharmacist’s name and contact information
- An action plan listing all discussed medication-related concerns
- Follow-up steps
You’ll also receive a personal medication list that includes:
- Your prescription and over-the-counter medications
- How to take each drug
- Why you are taking each drug
- Who prescribed each drug
The Centers for Medicare & Medicaid Services require that you receive a Targeted Medication Review (TMR) every three months if you’re enrolled in MTM. The pharmacy team will will send letters and then perform outreaches to conduct these reviews, during which time they will answer questions and help make sure you’re taking your medications as prescribed.