Medication Therapy Management (MTM) 2024

Get the full benefits from your medicines, safely and with confidence.

Our Medication Therapy Management (MTM) Program helps to ensure our members with complex health needs get the most benefit from the drugs they take. This voluntary program is free to members who qualify.

Taking medications as prescribed can affect your quality of life, longevity, health outcomes, and overall healthcare costs.

(Source: "Medication Adherence: The Elephant in the Room."

Do I qualify for medical therapy management?

Our MTM program targets members who are enrolled in our Drug Management Program or meet the following 3 criteria:

  1. Have at least 3 of the following chronic diseases: chronic heart failure (CHF), diabetes, high cholesterol, high blood pressure, and/or chronic obstructive pulmonary disease (COPD)
  2. Taking at least 8 Part D covered medications
  3. Have at least $5,330 in estimated annual Part D drug costs


How medication therapy management works

If you’re eligible for the MTM program, you’ll be automatically enrolled. Our team will reach out to let you know.

Here’s what to expect:

  • You’ll first receive a welcome packet by mail within 60 days of enrollment that explains the program. We’ll then contact you by phone to see if you received the packet and would like to participate in the MTM program. Participating in this program is not considered a covered benefit.
  • Once you decide to participate, a pharmacist or other health professional will give you a comprehensive medication review of all your medications. This review is done over the phone and typically lasts 10-15 minutes. The call may be longer or shorter depending on your specific needs.
  • You can talk about how best to take your medications, your costs, and any problems or questions you have about your prescription and over-the-counter medications.
  • After the comprehensive medication review is complete, our pharmacists will review your therapy goals and look at your medication regimen. They will then reach out to your physician(s) to make recommendations to improve your medication therapy outcomes, if needed.
  • You will also receive a written summary of this discussion in the mail. The summary has a Medication Action Plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions.
  • You will also receive a Personal Medication List that will include all the medications you’re taking and why you take them.
  • In addition, you will receive information on the safe disposal of prescription medications that are controlled substances.
  • Once enrolled in the MTM program, an additional service you will receive are targeted medication reviews (also known as TMRs). These are reviews based upon specific clinical issues and are completed quarterly. Targeted medication reviews are sent as letters and/or faxes to you and/or your prescriber regarding the information reviewed. If the specific issue is deemed to warrant additional outreach, a follow up call may be necessary to you and/or your prescriber to ensure optimum therapy is achieved. 

Have questions about MTM?

If we have a program that fits your needs, we will automatically enroll you in the program and send you information. MTM services are not a standard benefit and members must qualify to participate. If you decide not to participate, please notify us and we will withdraw you from the program. If you have any questions about these programs, please contact Member Services.

HMO: (844) 918-0114 

PPO: (844) 915-0234 

TTY: 711 

From October 1 to March 31, we’re available seven days a week from 8am to 8pm EST. From April 1 to September 30, we’re available Monday through Friday from 8am to 8pm EST.