What is the Medication Therapy Management (MTM) Program?
The Medication Therapy Management (MTM) Program is a free service for eligible members who may have multiple health conditions and who may be taking multiple medicines. The MTM Program was designed by doctors and pharmacists to help you get the best results from all of the medications you are taking. The MTM program will help you and your doctor make sure that your medicines are working to improve your health. To qualify for the MTM Program, you must be eligible. Eligibility details can be found below. If you qualify, you will be auto-enrolled into the program 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 not considered a part of the plan’s benefit.
How can I learn more about the MTM Program?
For information about the MTM Program and how to obtain MTM service documents or to see if you qualify, you can call the number on your member ID card.
Members who use their plan’s website or mobile app could also log in and, if qualified, schedule a comprehensive medication review (CMR) at a time convenient for them.
Wellpoint wants you to have every opportunity to participate in this program when and where convenient for you. That is why we also work with other health organizations to provide MTM services on our behalf. One of these organizations may contact you about completing a Comprehensive Medication Review (CMR) or other MTM services.
Partner organizations: Clinical Pharmacy Care Center – CarelonRx (833-215-1137), MedWatchers (866-536-7519).*
*Additional partner organizations may be added if they meet our rigorous requirements to service our members.
Who is eligible for the MTM Program?
You may qualify for the MTM Program if:
- You have 3 or more chronic health problems. These may include:
- Chronic Heart Failure (CHF)
- High blood fat levels (High Cholesterol)
- High blood pressure (Hypertension)
- Rheumatoid Arthritis (RA)
- You take 5 or more daily medicines in the following Medicare Part D drug classes:
- Antihyperlipidemics – lower cholesterol
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
- Oral Hypoglycemics
- You are spending $4,935 or more in 2023 on Part D covered medications
- Additionally, members that are enrolled in their Health Plan’s Drug Management Program(s) may be auto-enrolled in the MTM Program.
How does the MTM Program help me?
If you qualify for the MTM Program, you will be contacted and have the chance to speak one-on-one with a highly-trained pharmacist. Together, you and the pharmacist will complete a comprehensive medication review (CMR) of all your medicines and talk with you about:
- Any questions or concerns about your prescription or over-the-counter medicines, such as drug safety and cost
- Better understanding your medicines and how they work and how best to take them, safely and conveniently
What will I receive if I qualify for the MTM Program?
If you qualify for the MTM Program, you will receive:
- A welcome letter and/or phone call that tells you how to get started.
- A comprehensive medication review or CMR.
- The CMR typically takes about 15 to 30 minutes and will vary depending on your needs.
- The CMR can be scheduled at a time that works best for you.
- After you complete the CMR, a summary is mailed to you. The summary includes a medication action plan reviewing what you and the pharmacist discussed, with additional space for you to take notes or write down any follow-up questions. The action plan has steps you should take, including sharing with your doctor(s), to help you get the best results from your medications.
- You also will be mailed a personal medication list. It’s a list of all of the medicines that you take and the reasons why you take them. The medication list will help you keep track of your medications and how to use them the right way. View a blank copy of the personal medication list.
- Ongoing targeted medication reviews
- At least once every 3 months, your medicines will be reviewed, and you or your doctor will be contacted if there are recommendations for any changes in your medicines.
- You may get a letter or a phone call for this review.