Our Medication Therapy Management (MTM) program helps you and your doctor manage your medications

What is the Medication Therapy Management Program?

The Medication Therapy Management (MTM) Program is a part of your Medicare plan.
MTM can help make sure that you get the most benefit from the drugs you take by:

• Lowering the risk of medication errors; especially if you have chronic conditions, take many medications, or see multiple doctors
• Giving information on proven medical practices to help you and your doctor decide the most effective treatment
• Helping you understand your condition and medications, so you can take an active role in taking care of your health

How do I qualify?

You may qualify for program assistance if:
You have at least three (3) of the medical conditions below:

• Bone disease (osteoporosis)
• Chronic heart failure
• Diabetes
• Dyslipidemia
• Hypertension

You should take at least seven (7) drugs from selected classes:

• Alpha blockers
• Angiotensin II receptor blockers (ARB)
• Angiotensin-converting-enzyme (ACEI) inhibitors
• Antihyperglycemics
• Antihyperlipidemics
• Antihypertensives
• Beta blockers
• Bisphosphonates
• Calcium channel blockers
• Diuretics
• Insulins
• Oral hypoglycemic
• Other metabolic bone disease agents.
• Other heart failure drugs

Your prescriptions for the last three (3) months cost more than one-fourth of the yearly cost level. The Centers for Medicare & Medicaid Services (CMS) set a cost level each year. The 2022 cost level is $4,696

How do I get started?

Members who qualify for the MTM Program are automatically enrolled¹ and sent a welcome packet in the mail.

All enrolled members will be offered a comprehensive medication review (CMR) at least yearly. The CMR is an interactive session with one of our clinical pharmacists to talk about how best to take your medications, your costs, and any problems or questions you have about your prescription and over-the-counter medications.

After the CMR, we’ll mail a written summary of the discussion. The summary has a medication action plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions. You’ll also get a personal medication list that will include all the medications you’re taking and why you take them. Your doctor or pharmacist may also get a letter with possible changes to solve medication-related problems or other ways to optimize your medication use. We automatically give you a targeted medication review each quarter and mail your doctor or pharmacist a letter with intervention opportunities.

Getting involved in the MTM Program may help improve your health and lower your risk for medication reactions, hospitalization, and emergency room visits. Depending on your diagnosis, it may help improve your cholesterol and blood sugar levels, and lower your risk of heart attack.

Get a blank Personal Medication List (PDF)

Questions?

If you have questions or need more information, please call us at 1-866-393-5366 or 305-559-5366 (TTY 711). We’re here from 8:00 a.m. to 8:00 p.m., Monday to Friday.

You can schedule an appointment Monday - Friday, 8:00 a.m. - 5:00 p.m. For questions about health plan benefits, coverage issues, or claims, please contact us

¹Unless you opt-out of enrolling in the program.

The Medication Therapy Management (MTM) Program is a component of our prescription drug plans and should not be considered a Medicare benefit. MTM is neither offered nor guaranteed under our contract with the Medicare program and is not subject to the Medicare appeals process.