Medication Therapy Management (MTM) Program
We offer a FREE program to help our members better understand their medicines, including why and how they should be taking them to help improve their health. Members who take several medicines for different medical conditions may qualify for the FREE program.
What is the purpose of the MTM Program?
The MTM Program helps make sure that you understand how to take your medicines correctly and helps address your medicine-related concerns such as side effects, use of high-risk medicines, interactions between medicines and high cost of your medicines. Once a year, a pharmacist or another trained healthcare provider would talk to you over the phone about your medicines and occasionally, they would review your pharmacy claims throughout the year and evaluate for any issues. If we find any medicine related concerns that we believe need to be addressed, we will communicate those with you and your doctor.
How do you qualify for the MTM Program?
To qualify for the MTM Program, you must meet the following criteria:
- You have been diagnosed by your doctors with at least three of the following medical conditions: diabetes, high blood pressure, high cholesterol, chronic heart failure, osteoporosis, asthma, COPD, depression or ESRD (end stage renal disease), AND
- You have filled prescriptions for eight or more chronic maintenance Part D medicines, AND
- You and others on your behalf (including your health plan) have paid at least $1,174 for your medicines in the previous three months.
- You are taking multiple and/or high doses of opioid (medicines used to manage pain) medicines prescribed by multiple doctors from multiple pharmacies
If you qualify for the MTM Program, we will automatically enroll you in the program and send you a welcome packet in the mail.
What is a Comprehensive Medication Review, and how can you request one?
We offer all our members in the MTM Program an opportunity to review their medicines with a pharmacist or other trained healthcare provider over the phone. We call this a Comprehensive Medication Review (CMR). If you would like to have a CMR call, please contact Customer Service and request a CMR with a pharmacist.
Please have a list of your medicines or your medicine bottles with you at the time of your call. This includes prescription medicines, over-the-counter medicines, and supplements you are taking.
During the phone call you will have an opportunity to review your medicines in detail. We can talk about how to best take your medicines, your medicine cost concerns, and any other questions or concerns you might have about your medicines. We can also help you set health goals and make plans to accomplish those goals. Most calls take about 20 to 30 minutes. We are here to help and ready to address any questions or concerns you have about your medicines.
After the call, we will send you a written summary of the discussion. The summary has a medication action plan that recommends what you can do to make the best use of your medicines, with space for you to take notes or write down any follow-up questions. You will also get a personal medicine list that will include all the medicines you are taking and why you take them. Download a blank copy of our personal medicine list form here.
How can you get more information about the MTM Program?
If you would like more information or have questions about the MTM Program, please contact our Customer Service. If you misplace any program letters that we have sent you, please contact Customer Service and request that we send another letter. Again, there is no cost to you to participate in your health plan’s MTM Program.
What if you are enrolled in the MTM program, but do not want to participate in the program?
If you receive a MTM Program welcome packet from us, but do not wish to participate in the MTM Program, you can let us know by contacting our Customer Service.
If you previously told us that you did not want to participate in the MTM Program, but have changed your mind and now wish to participate, please contact Customer Service.