Medication therapy management

Reduce risks and costs when you take multiple medications

If you take multiple medications, you’re at increased risk for errors that can result in serious complications such as heart attacks, falls, blood clots and kidney failure.

Our medication therapy management (MTM) program aims to prevent such errors. The program is a collaboration between you, your pharmacist and doctors to ensure you take medications safely while achieving the best possible outcome.

While medication therapy management services are free for eligible members with Medicare Part D prescription drug coverage, as defined below, medication therapy management is not a plan benefit.

Benefits of medication therapy management include:

• Improved adherence: We’ll help you safely take medications as prescribed.
• Improved safety: Medication therapy management can help you avoid dangerous side effects and duplication of medications.
• Lower costs: The program has reduced members’ direct pharmacy costs by an average of 16% and indirect medical costs by 21%.

Who is eligible for the medication therapy management program?

You’re eligible for medication therapy management if you:

• Use eight or more medications
• Are likely to spend more than $1,276 on medications in 2026 or $1,340 in 2027
• According to clinical guidelines, have been identified as at-risk for potential misuse or abuse of frequently abused drugs
• Have at least three qualifying medical conditions from the list below:
  • 2026: Alzheimer's disease, osteoarthritis, rheumatoid arthritis, osteoporosis, depression, major depressive disorder, bipolar disorder, schizophrenia, chronic heart failure, diabetes, dyslipidemia, HIV/AIDS, hypertension, end-stage renal disease, chronic obstructive pulmonary disease (COPD), asthma, dementia, urge/stress incontinence, insomnia, Crohn's disease and plaque psoriasis
  • 2027: Alzheimer’s disease, dementia, osteoarthritis, rheumatoid arthritis, osteoporosis, depression, major depressive disorder, bipolar disorder, schizophrenia, chronic congestive heart failure, diabetes, dyslipidemia, HIV/AIDS, hypertension, end-stage renal disease, chronic obstructive pulmonary disease (COPD), asthma, urge/stress incontinence and insomnia

To review your pharmacy claim history, log in to the member portal.

If you’re eligible, we’ll contact you to explain the program and its potential benefits. Then, a pharmacy team member will contact you to answer your questions and set up an appointment with one of our medication therapy management pharmacists.

How does medication therapy management work?

Once you’re enrolled in medication therapy management, a pharmacist will call you to conduct a comprehensive medication review. During this review, the pharmacist will:

• Discuss your medications and answer questions
• Identify possible drug interactions
• Highlight potential ways to reduce your drug costs
• Determine if any medications need to be adjusted for safety or to improve your health

The pharmacist will work with your doctors to make any necessary medication changes. You will not need to change doctors or pharmacies for the medication therapy management program.

Within 14 calendar days after completing the review, you’ll receive a letter containing:

• Your medication therapy management pharmacist’s name and contact information
• An action plan listing all discussed medication-related concerns
• Follow-up steps

You’ll also receive a personal medication list that includes:

• Your prescription and over-the-counter medications
• How to take each drug
• Why you are taking each drug
• Who prescribed each drug

To help keep track of this information, download a medication list template.

The Centers for Medicare & Medicaid Services require that you receive a targeted medication review (TMR) every three months if you’re enrolled in medication therapy management. The pharmacy team will send letters and then perform outreaches to conduct these reviews, during which time they will answer questions and help make sure you’re taking your medications as prescribed.

Contact us with questions