Medication Therapy Management (MTM) Program

Are you enrolled in a Medicare plan with prescription drug coverage and have complex health needs? You may be able to participate in a Medication Therapy Management (MTM) program. This program helps you and your doctor make sure your medications are working for you. It also helps your doctor identify and reduce possible medication problems.

What is Medication Therapy Management?

If you have complex health needs, you’re probably taking several medications prescribed by more than one health care provider. This can increase your risk of side effects, medication-related problems or high medication costs.

The Medication Therapy Management program is a service offered by MDwise Medicare at no additional cost to you. It helps you manage your medications so they’re working for you. Medication Therapy Management services include:

  • A thorough review of all the medications you’re taking, along with the reasons you’re taking these medications
  • A review of any medication side effects
  • A review of any medication interactions
  • A review of your medication cost and coverage options

After this initial review, you’ll get an action plan to help you manage your medications and reduce side effects or drug interactions. We’ll also help you find out if you can lower your medication costs.

How to Qualify for Medication Therapy Management

All Medicare plans that offer drug coverage must offer free MTM services if you meet certain requirements set by the Centers for Medicare and Medicaid Services (CMS). Enrolling in the MTM program does not affect your Medicare coverage or your prescription drug coverage.

The Medication Therapy Management program is designed to help people who have complex health care needs or chronic conditions, and who take multiple medications. To qualify for MDwise Medicare’s MTM program, you must meet the criteria of one of the following groups:

Group 1

  • You have at least three chronic health conditions such as chronic heart failure, diabetes, dyslipidemia, hypertension, asthma, COPD, ESRD, depression, bipolar disorder, etc. AND
  • You take eight or more medications covered by Medicare, AND
  • Your covered medication costs will probably exceed $5,330 in 2024.

Group 2

  • You’re a potential at-risk beneficiary. This means there’s a risk you may misuse a medication that’s considered a frequently abused drug.

Group 3

  • You’ve had a drug-related hospital visit and been prescribed an opioid, OR
  • You’re taking an opioid medication prescribed by more than one health care provider

What to Expect from The MTM Program

The MDwise Medicare MTM program offers two types of clinical reviews to help you manage your medications:

  • Comprehensive Medication Review (CMR): Every year you can sit down with a pharmacist or health care professional to talk about your medications. You may also opt for a phone call using the confidential telephone service operated by Aspen RxHealth. The review usually takes about 30 minutes. During the review your health care provider will:

    • Review all the medications you’re taking, both prescription medications and over-the-counter medications
    • Discuss concerns about your medications, including side effects
    • Review any risk of medication interactions
    • Talk about safe disposal of prescription medications
    • Share information about any medication alternatives that could lower your drug costs

  • Targeted medication review: Every three months we’ll review all your prescription medications and contact you if we detect a potential problem. We’ll also notify your pharmacist and your doctor about any concerns.

After the comprehensive medication review, you’ll get a written summary of the review. You can take this with you to your next doctor's appointment. The summary includes:

  • Your Personal Medication List (PML) – The medication list will help you keep track of your medications and how to use them the right way.
  • Your Medication Action Plan (MAP) – The action plan has steps you can take to get the best results from your medications.

You can also download your Personal Medication List to help you and your health care providers keep track of the medications you are taking.

Learn More About MDwise Medicare’s MTM Program

If you manage chronic health conditions with multiple medications, contact us to see if you’re eligible for the Medication Therapy Management program. Qualifying beneficiaries receive a letter in the mail inviting them to participate in the program. This package will also include more information about the program, and details on how to set up your first comprehensive medication review.

Find out if you’re eligible for the MTM plan by contacting your plan provider or contacting our customer service team at 800-910-4691 (TTY: 711).

CMS Material ID: H7746_MDwiseWebsite
Updated: 6/15/2024 11:56:45 AM