What is the Medication Therapy Management (MTM) program?
The medication therapy management (MTM) program is a service for members with multiple health conditions and who take multiple medicines. The MTM program helps you and your doctor make sure that your medicines are working to improve your health.
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. You may choose not to participate in the program, but it is recommended that you make use of this free service.
The MTM program is offered through our partnership with Express Scripts Inc. and the Medicare Therapy Management vendor, SinfoniaRx. The MTM program is not considered a part of the plan’s benefit.
Who is eligible for the MTM program?
You may qualify for the MTM program if:
- You have three or more chronic health problems. These may include:
- Chronic heart failure (CHF)
- Chronic obstructive pulmonary disease (COPD)
- End-stage renal disease (ESRD)
- High blood fat levels
- High blood pressure
- You take seven or more daily medicines covered by Medicare Part D.
- You spend $3,919 or more per year on Part D covered medications.
How does the MTM program help you?
If you qualify for the MTM program, you will be contacted and have the chance to speak with a highly trained pharmacist or a pharmacist intern who is under the direct guidance of a pharmacist. During that call, the pharmacist or pharmacy intern will complete a comprehensive medication review of your medicines and talk with you about:
- Any questions or concerns about your prescription or over-the-counter medicines, such as drug safety and cost.
- Better understanding your medicines and how to take them.
- How to get the most benefit from your medicines.
What will you receive?
If you qualify for the MTM program, you will receive:
- A welcome letter that tells you how to get started.
- Full medication review.
- You will have the chance to review your medicines with a highly trained pharmacist or a pharmacist intern under the direct guidance of a pharmacist each year. This review will take about 20-30 minutes. During this call any issues with your medicines will be discussed. The call can be scheduled at a convenient time for you.
- After you complete the full medication review, a summary is mailed to you. The summary includes a medication action plan with space for you to take notes or write down any follow-up questions.
- You also will be mailed a personal medication list that lists all of the medicines that you take and the reasons why you take them.
- View an example of the full medication review letter:
- Ongoing targeted medication reviews.
- At least once every three months, your medicines will be reviewed, and you or your doctor will be contacted if you should think about any changes in your medicines.
- You may get a letter or a phone call for this review.
How can I learn more about the MTM program?
For more information about the MTM program or to see if you qualify, you can call The Health Plan toll-free at 1.800.624.6961, ext. 7914 Monday through Friday from 8:00 a.m to 5:00 p.m.(TTY/TDD users: 711).