Medication Therapy Management (MTM)
What is the Medication Therapy Management (MTM) program?
The Medication Therapy Management (MTM) program is a service for members who may have multiple health conditions and who may take multiple medicines. The MTM Program was designed by doctors and pharmacists to help you get the best results from all of the medications you are taking. 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 you meet all of these requirements:
1. You have three or more chronic health problems. These may include:
- Chronic heart failure (CHF)
- High blood fat levels (High cholesterol)
- High blood pressure (Hypertension)
- Rheumatoid arthritis (RA)
2. You take eight or more daily medicines covered by Medicare Part D
3. You are spending $4,696 or more in 2022 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 1-855-878-1784 (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.
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
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 – IngenioRx (833-215-1137), MedWatchers (866-536-7519), OutcomesTM – Patient Engagement Team.
*Additional partner organizations may be added if they meet our rigorous requirements to service our members.
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).
H8786_22_3001603_R CMS Approved 01/21/2022