MTM Program

If you take medications for different medical conditions, you may be eligible to get help, at no cost to you, through our Medication Therapy Management (MTM) program. The program helps you and your doctors make sure that your medications are working to improve your health. The MTM program is not a benefit. Your participation is voluntary, and does not affect your coverage.

To be eligible for the MTM program, you must:

  • Have at least 3 (three) of the following specific chronic diseases:
      • Chronic Heart Failure (CHF)
      • Diabetes
      • Dyslipidemia
      • Hypertension
      • Respiratory Disease-Asthma
      • Respiratory Disease-Chronic Obstructive Pulmonary Disease (COPD)
  • Be on at least 8 (eight) chronic maintenance medications
  • Have incurred one-fourth of the specified annual cost threshold of Part D drugs in the previous three (3) months. For 2024, the amount is $5,330.00

We will contact you if you are eligible to participate in this program. Your participation is voluntary, and does not affect your coverage. If you agree to participate, a pharmacist or other health professional will call you and conduct a Comprehensive Medical Review (CMR) of all your medications and talk with you about:

  • How to get the most benefit from the drugs you take
  • Any concerns you have, like drug reactions or potential side effects
  • How best to take your medications
  • Any other questions you have about your prescription and over-the-counter medications

After the CMR is completed, we will send you general education information, and a letter to describe your medication regimen, highlight any problems identified, and set goals. Targeted Medication Reviews may also be performed when follow up is required.

Here is a blank copy of the Personal Medication List for tracking your prescriptions.

Quality Assurance and Drug Utilization Management Information: The Quality Assurance program is designed to ensure that our members receive high quality, medically appropriate and cost effective health care.

To obtain  MTM documents or for further information, call us at 1-800-362-2266 and TTY/TDD: 711 , 8 a.m. to 8 p.m., 7 days a week.

Please Click here to learn about Safe Disposal of Prescription Medications.

Last updated on March 22, 2024