Medication Therapy Management Program

Our Medication Therapy Management (MTM) Program is not a benefit but is a free service to eligible members that is designed to help members learn more about their medications and how they affect their health and well-being. We want our members to have all the information they need about their medications.

This opportunity includes a review of your medications with our pharmacy clinical team via telephone and discusses any concerns or questions you may have. This includes over-the-counter (OTC) drugs, such as vitamins and supplements that your provider may not be aware of. This service works in partnership with your provider. You and your provider are still in control of your medications.

To make the most of this service, we have partnered with CSS Health (CSS). CSS will have a member of their pharmacy team call you to talk with you about your medications. This is a one-time call. You can have a member of your family be on the phone too, or, with your permission, your family member can be the one to speak with CSS about your medications. We encourage you to complete your medication review prior to your yearly check-up. You can use the summary to discuss your drug therapy with your provider.

How can this help you?

You may be able to learn more about your medications and how they affect your health and well-being. We want our members to have all the information they need about their medications. The call may identify medications that don’t work well together or that may cause unpleasant side effects. There also may be ways to make it easier for you to take your medications, such as the time of day you take them or how often, and ways to help you remember to take your medications.

There may also be ways to help you find alternative medications with lower copays. Finding less expensive medications may be important if you have a deductible plan, are in your Coverage Gap (also known as the Donut Hole) or are in the Catastrophic Coverage phase.

Your provider may also find this additional information helpful.

Who is eligible for the MTM Program?

Members who 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 prescriptions

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

    OR
  • Opioid pharmacy claims equal to or greater than 90 Morphine Milligram Equivalents**, AND
  • Five or more opioid prescribers,

    OR
  • Any Morphine Milligram Equivalent** level, AND
  • Seven or more opioid prescribers or seven or more opioid dispensing pharmacies

Group 3:

  • 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 is to gather information to conduct a comprehensive medication review. The medication review is intended to work 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
  • Helping you to remember to take your medications on time
  • 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, your complete medication list, 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.

We also perform one or more quarterly targeted medication reviews that focus on specific actual or potential medication-related problems. These are usually fax notifications to your provider. Depending on the reason for the follow-up, you may receive a phone consultation or a mailed letter.

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?

We believe that you will benefit from this program and learn more about your medications and hope that you will take advantage of this opportunity.

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, 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.

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 1/6/2022.