Medication Therapy Management Program

Our Medication Therapy Management (MTM) Program is not a benefit but is a free service that is designed to help you stay healthy while taking multiple prescription medications. The program is free to eligible members.

Who is eligible for the MTM Program?

Members are eligible if they are enrolled in a Medicare Part D plan AND meet the characteristics of at least one of the following three groups:

Group 1:

  • Taking at least eight Part D drugs, AND
  • Have three or more chronic conditions,* AND
  • Are spending an annual amount of $4,696 or more on Part D prescription

Group 2:

  • Opioid pharmacy claims equal to or greater than 90 Morphine Milligram Equivalents**, AND
  • Three or more opioid prescribers, AND
  • Three or more opioid dispensing pharmacies
  • Opioid pharmacy claims equal to or greater than 90 Morphine Milligram Equivalents**, AND
  • Five or more opioid prescribers,
  • Any Morphine Milligram Equivalent** level, AND
  • Seven or more opioid prescribers or seven or more opioid dispensing pharmacies

Group 3:

  • Are at-risk beneficiaries (ARBs) - that is, members with an active coverage limitation under a Drug Management Program (DMP)

If you are eligible, you will receive a letter from us explaining the program and notifying you that you have been enrolled in the program. After you receive the letter, a member of the Medication Therapy Management team will contact you by phone, unless you call the number on the letter saying that you do not want to participate (“opt out”).

* Qualifying chronic conditions include: high blood pressure, high cholesterol, diabetes, heart failure, COPD (chronic obstructive pulmonary disease) and depression. 

**Morphine Milligram Equivalents are a way to compare different opioid medications based on their strength as compared to morphine.

What do I receive as an MTM Program participant?

Enrolled members will receive at least one comprehensive, interactive phone consultation with a clinical team member.

The purpose of the phone consultation, which usually takes only 30 minutes or less, is to gather information to conduct a comprehensive medication review. The medication review is not intended to interfere with the care already provided by your doctors.

The medication review may include:

  • Checking for drug-to-drug interactions, including interactions with your over-the-counter medications
  • Offering solutions that may reduce any side effects from your medications
  • Identifying less expensive medication alternatives
  • Presenting ways to simplify your medication regimen
  • Monitoring your medications and medical conditions (such as high blood pressure, high cholesterol or diabetes) to be sure you’re getting the most out of your medications

We'll give you a written summary of the review and a list of any recommendations made by the pharmacists. We encourage you to complete your MTM review prior to your yearly check-up. You can use the summary to discuss your drug therapy with your provider.

You will also receive one or more quarterly targeted medication reviews that focus on specific actual or potential medication-related problems. 

At least annually, you will receive information about safe disposal of prescription drugs, drug take back programs, in-home disposal and cost-effective means to safely dispose of such drugs.

Who can I contact for more information about MTM?

For more details, call us toll-free at 1-800-325-5669 (TRS 711), 8 a.m.–8 p.m., Monday–Friday. (Oct. 1–March 31, seven days a week.)

You can also call us to get copies of letters that we have sent you, blank medication lists or educational materials. You may also print a blank medication list (pdf). The blank medication list is to help you keep track of the medications you are taking.

Call us toll-free at 1-888-340-5504 (TRS 711), 8 a.m.–8 p.m., seven days a week.
(Apr.–Sept., we are available 8 a.m.–8 p.m., Mon.–Fri.)

H9001_220181_C | The information on this page was last updated on 10/1/2021.