What is the Medication Therapy Management program?
Medication Therapy Management (MTM) is a Medicare-designed program that promotes collaboration between you, your pharmacist and your prescribing doctor to ensure safe and effective medication use. It aims to improve health outcomes by focusing on safety, effectiveness, lower-cost alternatives and adherence. This service is provided at no additional cost to qualified members and is not considered a Medicare Part D benefit.
Most of our members take multiple medications, and these may be prescribed by more than one healthcare professional. Some of those medications, when combined, may:
- Reduce the effectiveness of one or more of your medicines
- Cause side effects
- Cost you more money per month
As part of our MTM program, you may set up a one-on-one meeting with a pharmacist to go over your medications. This is called a Comprehensive Medication Review (CMR) and is offered at no cost to you. If the pharmacist who completes your CMR identifies a potential medication issue that needs attention, you may be contacted about a Targeted Medication Review (TMR).
What can I expect when I complete a CMR?
A trained pharmacist or healthcare provider will review your current medication program to:
- Go over the medications you are currently taking
- Make sure your medications are safe for you
- Answer any questions you may have about your medications
- Discuss possible lower-cost alternatives for your medications
- Discuss any concerns you have about your medications
- Work with you on ways to keep track of your medications
- Send you a summary of your consultation that includes a Personal Medication List, which is a list of all of the medications you’re taking, and a To-Do list, which includes things that you talked about with the MTM provider
Each consultation takes about 15 minutes to complete but can range from about 10–30 minutes.
How you qualify for the program
CarePlus determines monthly eligibility by looking at your medication claims information. To qualify for the MTM program, you must meet all three of the following criteria:
- Have at least three of the following conditions:
- Alzheimer’s disease
- Bone disease, arthritis (including osteoporosis, osteoarthritis and rheumatoid arthritis)
- Chronic congestive heart failure (CHF)
- Diabetes
- Dyslipidemia
- End-stage kidney disease (ESKD), also referred to as end-stage renal disease (ESRD)
- Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
- Hypertension
- Mental-health condition (including depression, schizophrenia, bipolar disorder and chronic/disabling mental health conditions)
- Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and chronic lung disorders)
AND
- Take eight or more chronic maintenance (Part D) prescription drugs
AND
- Likely to incur annual Part D medication costs of at least $1,340 for 2027
OR
- You qualified for the Drug Management Program because you're in a drug management program to help better manage and safely use medications such as opioids and benzodiazepines
Once you qualify, you remain in the program for the rest of the calendar year. If you qualify for the program for the next calendar year, you will be automatically re-enrolled.
How we notify you of your MTM eligibility
Once eligible, you will receive a letter that invites you to call Member Services to schedule your medication review. The review will last approximately 25 minutes, and we will schedule it at your convenience.
As part of your medication review, the pharmacist will:
- Go over the medicines you currently take
- Check to see if your medicines are safe for you
- Answer any questions you may have about your medicines
- Discuss lower-cost alternatives for your medicines
- Discuss your concerns about your medicines
- Work with you on ways to keep track of your medicines
CarePlus also works with other health organizations that provide MTM services on our behalf. One of these organizations may contact you about completing a Comprehensive Medication Review or other MTM service.
Partner organization: MedWatchers, Outcomes
You will receive a personal medication list and a summary of the medication review results (medication action plan). The medication list will help you keep track of the medications you take. The medication summary will offer you steps you can take to get the best results from your medications.
Below, we include a blank medication list you can print. Please use the form to keep track of all your prescriptions and over-the-counter medications.
