Medicare Advantage (Part C) Plans & stand-alone Medicare Prescription Drug (Part D) Plans
The Medication Therapy Management (MTM) program reviews the medicines you take to make sure that they’re safe, work well and fit your lifestyle. This program is offered at no additional cost to eligible members. This service is not considered a benefit.
The goal is to help you get the best results from your medicines, at the lowest possible price. The MTM program is the right choice if you need answers to questions below.
- Why am I taking these medicines?
- Do over-the-counter products interact with my prescriptions?
- Can I save money on my prescriptions?
The program can also help you and your doctor make sure that your medicines are the best choice for you.
You're automatically enrolled in the MTM program if you meet the criteria listed below.
Have three or more of the following conditions:
- Atrial Fibrillation
- Chronic Heart Failure (CHF)
- End-Stage Renal Disease (ESRD)
- High blood pressure
- High blood cholesterol
- Respiratory Disease - Chronic Lung Disorders
Take eight or more prescription medications covered by Medicare Part D.
On prescription medicines covered by Medicare Part D, expect to spend more than:
- $4,935 in 2023
- Yearly Comprehensive Medication Review (CMR)
- Quarterly Targeted Medication Review (TMR)
These services are provided by telephone, or, in some cases, in person.
The MTM program is a two-part program. Reviews may be done over the phone, whenever it’s convenient for you. In some cases, you may have an in-person review.
For a Comprehensive Medication Review (CMR)
This personalized review lets you talk one-on-one with an MTM pharmacist.
To get ready for your review make a list of all the medicines you take. Write down even over-the-counter medicines or supplements. Include how much you take each day and how often you take them. The pharmacist will review your list and talk about it with you. This usually takes about 30 minutes.
After your review, you’ll get a complete list of your medicines — a personal medication list and an action plan that you can bring with you to your next doctor’s visit.
For a Targeted Medication Review (TMR)
Every few months, the program reviews your prescription claims to make sure there are no issues that need attention. If the review identifies any issues, we may contact your doctor.
If you’re eligible for MTM, you’re automatically enrolled. You’ll get a letter or phone call letting you know how to schedule an appointment or opt out of the program.
Medicare requires us to automatically enroll you if you’re eligible. But, this service is voluntary — you’re not required to participate. You may also choose to take part in only certain services you find valuable. You can change your enrollment status at any time during the calendar year. Your prescription drug coverage will not change if you take part in the MTM program or not.