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Medication Therapy Management (MTM)

What is the Medication Therapy Management (MTM) program?

The Medication Therapy Management (MTM) program is a service for members with multiple health conditions who take multiple medicines. The MTM program helps you and your doctor make sure your medicines are working to improve your health.

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?

You may qualify for the MTM program if:

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

  • Chronic heart failure (CHF)
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Rheumatoid arthritis

2. You take eight or more daily medicines covered by Medicare Part D

3. You spend $4,376 or more per year on Part D covered medications

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 1-855-878-1784 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. local time. The call is free.5

How does the MTM program work?

Once in the program, you will receive:

1. A comprehensive medication review

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 with space for you to take notes or write down any follow-up questions.
  • A personal medication list that lists all of the medicines that you take and the reasons why you take them.

View and print a blank personal medication list here .

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 under-utilization and reduce costs. These programs include but are not limited to:

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

Learn more about the MTM program

Call Member Services toll-free at 1-855-878-1784 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. local time to learn more about the program and see if you qualify.

The MTM Program is offered in collaboration with IngenioRx, a separate company that manages pharmacy services and benefits for health plan members.

IngenioRx, Inc. is a separate company providing utilization review services on behalf of Amerigroup STAR+PLUS MMP (Medicare-Medicaid Plan).

Updated 01/01/2021
H8786_21_127705_R CMS Approved 01/21/2021