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 who are enrolled in a Medicare Part D plan, taking at least eight prescriptions, have three or more chronic conditions* and are spending an annual amount of $4,044 or more on prescriptions are eligible. If you're eligible, you'll receive a letter from us explaining the program and enrolling you. 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 don’t want to participate (“opt out”).

You are also eligible if you are in a Medicare Part D plan and have high opioid usage:

  • Opioid pharmacy claims equal to or greater than 90 Morphine Milligram Equivalents (MME)**,
  • Three or more opioid prescribers,
  • And three or more opioid dispensing pharmacies

* Qualifying chronic conditions include: heart failure, high blood pressure, high cholesterol, diabetes, COPD (chronic obstructive pulmonary disease) and depression.
**MME is a way to compare different opioid medications so that they are all in terms of morphine equivalents.

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 and one or more quarterly targeted medication reviews.

The consultation is done by phone. The purpose of the 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 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 send 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.

Who can I contact for more information about medication therapy management?

For more details, call Enrollee Services at 1-877-700-6996 (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, to get blank medication lists or to get 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.


Fallon Health is an HMO plan with a Medicare contract and a contract with the Massachusetts Medicaid program. Enrollment in Fallon Health depends on contract renewal. NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.

The information on this page was last updated on 10/1/2018.

Medicare Part D online forms