Who can participate in the MTM program?

Members who meet all three of the following criteria are eligible for the MTM program.

  1. Members who have at least three of the following chronic diseases:
    • Asthma
    • Cardiovascular Disease
    • Chronic Heart Failure
    • Diabetes
    • Mental Health Disorders, including depression
    • Osteoporosis
    • Chronic Obstructive Pulmonary Disease (COPD)
  2. Members who are taking at least eight chronic/maintenance Part D covered drugs per month
  3. Members who have incurred costs for Part D covered drugs of at least $4,696.00 annually or at least $1,174.00 quarterly.

The MTM Program is designed to:

  • Provide helpful information about the medications you take to manage your chronic diseases
  • Reduce your risk of drug reactions and harmful side effects
  • Help you use your medications as effectively as possible

How will I know if I'm selected?
We will mail you a letter to let you know if you qualify for the MTM program. An MTM program pharmacist will then schedule a one-on-one medication review with you.

The pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the pharmacist may contact your prescribing doctor. A Comprehensive Medication Review (CMR) takes about 30 minutes and is usually offered once each year-if you qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List of the medications you discussed during your CMR.

We will mail or fax a Targeted Medication Review (TMR) to your doctor every three months. The TMR includes suggestions regarding prescription drugs that may be safer or more efficient than the drugs you currently take. Your prescription drugs will not change unless you and your doctor decide to make the change.

If you have additional questions, please call us at 844.866.3735, 24 hours a day, 7 days a week. TTY user: 711.


Updated October 6, 2021