MMP Medication Therapy Management

If you qualify, a pharmacist or other health professional will review all of your medicines and talk with you about:

• How to get the most benefit from the medicines you take. 
• Questions or concerns you have, such as drug safety and cost.
• The best way to take your medicines.

Who is Eligible for the MTM Program?

You may qualify for the MTM program if you meet all of these requirements:

1. You have 3 or more chronic health problems. These may include:

• Chronic Heart Failure (CHF)
• Diabetes
• High blood fat levels (High Cholesterol)
• Alzheimer’s Disease (AD)
• Rheumatoid Arthritis (RA)

2. You take 6 or more daily medicines in the following Medicare Part D drug classes:

• Antihyperlipidemics – to lower cholesterol
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs) – to treat rheumatoid arthritis
• ACE-Inhibitors – to treat Chronic Heart Failure
• Angiotensin II Receptor Blockers (ARBs) – to treat Chronic Heart Failure
• Insulins – to help lower blood sugar levels
• Oral Hypoglycemics – to help lower blood sugar levels
• Acetylcholinesterase Inhibitors – to treat the symptoms of Alzheimer’s disease
• N-Methyl-D-Aspartate (NMDA) Receptor Antagonists – to treat the symptoms of Alzheimer’s Disease

3. You are spending $5,330 or more in 2024 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.

To see if you qualify, call Member Services at 855-878-1784 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. local time. The call is free.

How does the MTM program work?

Once in the program, you will receive:

1. A comprehensive medication review (CMR)

You will have the chance to review your medicines with a pharmacist or other healthcare professional. During this call, any issues with your medicines will be discussed. The call will take about 20-30 minutes and can be scheduled at a convenient time for you.

After the review, a summary is mailed to you that includes:

• A medication action plan summarizing what you and the pharmacist discussed, with space for you to take notes or write down any follow-up questions. You should share this summary with your doctor(s).
• A personal medication list that lists all of the medicines that you take and the reasons why you take them.

Download or print a blank personal medication list.

2. Ongoing targeted medication reviews

Your medicines will be reviewed at least once every three months. You or your doctor may be contacted about any suggested changes to your medicines.

Quality Assurance and Utilization Management

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

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

Your health insurance provider wants you to have every opportunity to participate in this program when and where convenient for you. That is why we also work with other health organizations to provide MTM services on our behalf. One of these organizations may contact you about completing a Comprehensive Medication Review or other MTM services.

Partner organizations: Clinical Pharmacy Care Center – CarelonRx, MedWatchers, CVS, OutcomesMTM

* Additional partner organizations may be added if they meet our rigorous requirements to service our members.