Medicare Medication Therapy Management (MTM) Program

The MetroPlus Health Plan MTM program helps you get the greatest health benefit from your medications by:
  • Preventing or reducing drug-related risks
  • Increasing your awareness 
  • Supporting good habits 
Who qualifies for the MTM program?
We will automatically enroll you in the MetroPlus Health Plan MTM program at no cost to you if all three conditions apply:
  1. You take eight or more Medicare Part D covered maintenance drugs, and
  2. You have three or more of these long-term health conditions: 
    • Asthma
    • Chronic obstructive pulmonary disease (COPD)
    • Diabetes
    • Depression
    • Osteoporosis
    • Chronic Heart Failure
    • HIV
    • Cardiovascular Disorders such as high blood pressure, high cholesterol, or coronary artery disease
  3. You reach $3,919 in yearly prescription drug costs paid by you and the plan.
Your participation is voluntary, and does not affect your coverage. This program is free of charge and is open only to those who are invited to participate. The MTM program is not a benefit for all members.

What services are included in the MTM program?
The MTM Program provides you with a:
  • Comprehensive medication review (CMR), and a
  • Targeted medication review (TMR) 
Comprehensive Medication Review (CMR) 
A CMR is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:
  • Prescription drugs
  • Over-the-counter (OTC) medicines
  • Herbal therapies
  • Dietary supplements and vitamins
The pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the pharmacist may contact your prescribing doctor. A CMR review takes about 30 minutes and usually offered once each year—if you qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List with the medications you discussed during your CMR.

You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

Here is a blank copy of the Personal Medication List for tracking your prescriptions.

Targeted Medication Review (TMR) 
With a TMR, we mail or fax suggestions to your doctor every three months about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them.

How will I know if I qualify for the MTM program?
If you qualify, we will mail you a letter letting you know that you qualify for the MTM program. Afterward, you may receive a call from the pharmacy, inviting you to schedule a one-on-one medication review at a convenient time.

Will the MTM program pharmacist be calling from my regular pharmacy?
Yes. The MTM program pharmacist may be calling from your regular pharmacy if your regular pharmacy chooses to participate in the MTM program as a service provider. You will be given the option to choose an in-person review or a phone review.

If your regular pharmacy does not participate in the program, you may be contacted by a call center pharmacist to provide your MTM review, and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.
 
Why is a review with a pharmacist important?
Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:
  • Discuss how your prescription drugs and OTC medications may affect each other.
  • Identify any prescription drugs and OTC medications that may cause side effects, and offer suggestions to help.
  • Help you get the most benefit from all of your prescription drugs and OTC medications.
  • Review opportunities to help you reduce your prescription drug costs.
How do I benefit from talking with a pharmacist?
  • Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely.
  • The pharmacy can look for ways to help you save money on your out-of-pocket prescription drug costs.
  • You benefit by having a Personal Medication List to keep and share with your doctors and health care providers.
How can I get more information about the MTM program?
Please contact us if you would like additional information about our MTM Program, or if you do not want to participate after being enrolled in the program. Our toll free number is 1.844.635.3406, 24 hours a day, 7 days a week. TTY users, call 711.