Medication Therapy Management

You will be automatically enrolled in this program if you meet all three of the following criteria:

• You take eight or more Medicare Part D–covered medications.
• You have three or more of the following conditions or diseases:
  • Bone disease (such as arthritis or osteoporosis)
  • Chronic heart failure
  • Diabetes
  • Dyslipidemia (high cholesterol)
  • Hypertension (high blood pressure)
• The following conditions are being added for 2025 plan members
  • Alzheimer’s disease
  • End-Stage Renal Disease (ESRD)
  • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
  • Mental Health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
  • Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
• You have Part D–covered medications with a total cost that is more than the amount listed below:
  • For 2024 plan members: $5,330
  • For 2025 plan members: $1,623

You will be automatically enrolled in this program if you were identified as an ‘At-Risk beneficiary’ through our Drug Management Program whether or not you’ve met the three criteria mentioned above.

If you meet these criteria, we will send you a letter inviting you to take part in the program and give you more information about how it can help keep you healthy. Enrollment in MTM is voluntary, but we strongly encourage you to take advantage of this free service.

No, enrollment in MTM does not affect your Medicare coverage for drugs.

We will review your prescription medications every 3 months, and if we find a potential problem, we will contact you, your caregiver if you wish, your pharmacist, and maybe your doctor, as well.

After you qualify for the MTM Program, a pharmacist or other health professional from our partner, Arine,  will call you to discuss ways to use your medications safely. This conversation can also be held in person or by telehealth at your pharmacy or doctor’s office, if one of those options works better for you. The conversation usually lasts about 10 to 30 minutes.

After the annual review, you will get a written summary of this call within a few days (between 5-14 days), which you can take with you when you talk with your doctors. This summary includes:

• Medication action plan with steps you should take to help you get the best results from your medications
• Personal Medication List (PML) to help you keep track of your medications and how to use them the right way

To obtain a blank copy of the PML for you and your health care providers so you can keep track of your medications, click here.