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Medication Therapy Management

We have a number of Quality Assurance and Utilization Management Initiatives designed to improve quality, prevent over- and under-utilization and reduce costs. These programs include but are not limited to:

  • Medication Therapy Management (MTM)
  • Concurrent Drug Utilization Review
  • Retrospective Drug Utilization

What is the Medication Therapy Management (MTM) Program?

The MTM program is a service for members who may have multiple health conditions and who may take multiple medicines. The MTM Program was designed by doctors and pharmacists to help you get the best results from all of the medications you are taking. This program helps you and your doctor make sure that your medicines are working to improve your health.

Who is eligible for the MTM Program?

To qualify for the MTM program, you must be eligible. Please see below for those details. If you qualify, you will be auto-enrolled into the program and the service is provided at no additional cost to you.

  1. You have three or more chronic health problems. These may include:
    • Chronic Heart Failure
    • Diabetes
    • High blood fat levels (High cholesterol)
    • High blood pressure (Hypertension)
    • Rheumatoid Arthritis (RA)
  2. You take eight or more daily medicines covered by Medicare Part D.
  3. You are spending $4,696 or more in 2022 on Part D covered medications.

    Additionally, members that are enrolled in their Health Plan’s Drug Management Program(s) may be auto-enrolled in the MTM Program.

If you qualify, you’ll be automatically enrolled into the program at no additional cost to you. You may choose not to take part in the program, but we strongly suggest that you take advantage of this opportunity to better understand your medications.

Get more information about the MTM Program

Download the PDF below to get more details about the Medication Therapy Management (MTM) program and how it may help you.

H6229_22_3001706_U CMS Accepted 12/29/2021 Page Last Updated on 01/01/2022