Medication Therapy Management Program

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What is the Medication Therapy Management (MTM) program?

The Medication Therapy Management (MTM) program is a free service for members with multiple health conditions who take multiple medicines. The MTM program helps you and your doctor make sure that your medicines are working to improve your health. It also helps identify and reduce possible medication problems. To help members get the best results from their medications, The Health Plan has partnered with Express Scripts to offer the MTM program.

To qualify for the MTM program, you must be eligible. Please see below for those details. If you qualify, you will be auto-enrolled into the program and the service is provided at no additional cost to you. You may choose not to participate in the program, but it is recommended that you make use of this free service. The MTM program is required by the Centers of Medicare and Medicaid Services (CMS) and is not considered a part of the plan’s benefit. 

 

Who is eligible for the MTM program?

You may qualify for the MTM program if:

1. You have been identified as an at-risk beneficiary; OR

2. You take seven or more daily medicines covered by Medicare Part D; AND
   You spend $5,330 or more per year on Part D covered medications; AND
   You have at least three or more chronic health problems. These may include:
   • Asthma
   • Chronic heart failure (CHF)
   • Chronic obstructive pulmonary disease (COPD)
   • Depression
   • Diabetes
   • End-stage renal disease (ESRD)
   • High blood fat levels
   • High blood pressure
   • Osteoporosis 

 

What will I receive?

If you qualify for the MTM program, you will receive:

• A welcome letter that tells you how to get started.

• A full medication review also known as a comprehensive medication review.
  • You will have the chance to speak to a pharmacist or other health professional about your medications.  The pharmacist will meet with you face-to-face or by phone to review your prescriptions, vitamins, herbals, supplements, and other over-the-counter medications. 
  • This review will take about 15-30 minutes. During this call, you can ask any questions or discuss any issues about your medicines
  • After you complete the full medication review, a summary is mailed to you. The summary includes a recommended to do list with steps you should take and a personal medication list.  The personal medication list helps you keep track of your medications, explains how to use them, and lists the reasons why you are taking them.
  • View an example of the full medication review letter: 2024 ESI Post-CMR Standard Format Letter English.pdf

• Ongoing targeted medication reviews.
  • At least once every three months, your medicines will be reviewed, and you or your doctor will be contacted if you should think about any changes in your medicines.
  • You may get a letter or a phone call for this review.

 

How does the MTM program help?

If you qualify for the MTM program, you will be contacted and have the chance to speak with a pharmacist, a pharmacist intern who is under the direct guidance of a pharmacist, or other health professional. During the call, they will complete a comprehensive medication review with you and may talk with you about:

• Any concerns you have about your prescriptions or over-the-counter medicines, such as side effects, medication conflicts, and duplicate treatments.
• Ways to save you money.
• Better understanding your medicines and how to take them.
• How to get the most benefit from your medicines.
• Answer any questions you have about your medicine. 

 

How can I learn more about the MTM program?

For more information about the MTM program or to see if you qualify, you can call Express Scripts at 1-855-723-7009 (TTY/TDD 711), Monday through Friday from 9:00 am to 7:00 pm Eastern.

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