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Medicare

Medication therapy management program

A free program to help Medicare members with complex health needs.

Understand your medication

Members enrolled in Blue Medicare HMO℠, Blue Medicare PPO℠, Healthy Blue + Medicare℠, or Experience Health Medicare Advantage℠ (HMO) with Medicare prescription drug benefits or Blue Medicare Rx℠ may be eligible for the Medication Therapy Management Program (MTM), in accordance with CMS requirements.

The MTM Program helps members understand their medications better by: 

  • Educating members regarding their medications
  • Increasing understanding about how to take medications as prescribed
  • Identifying and prevent medical complications related to medication therapy

What members receive

The MTM Program includes interventions for members and prescribers, such as an annual comprehensive medication review (CMR) with a pharmacist or nurse to go over prescription and non-prescription medications that you take.

The appointment usually takes about 30 minutes. During that time the pharmacist will:

  • Review the medicines you take
  • Create a personal medicine list
  • Help you understand how your medicines work
  • Tell you about side effects from your medicines
  • Answer any questions or concerns you have

The program also includes a Quarterly Targeted Medication Reviews, which look for any safety or other issues which may need attention. The member’s prescriber may be contacted if any issues are found.
Member eligibility

To be eligible for the MTM program, Medicare members must meet all of three criteria and / or have an active coverage limitation for an opioid or frequently abused medicine as a result of a Drug Management Program.

Required criteria includes:

  • Have at least three of the following chronic conditions:
    • Alzheimer's disease
    • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
    • Chronic congestive heart failure (CHF)
    • Diabetes
    • Dyslipidemia
    • End-stage renal disease (ESRD)
    • Human immunodeficiency virus / acquired immunodeficiency syndrome (HIV / AIDS)
    • Hypertension
    • Mental health (including depression, schizophrenia, bipolar disorder, and chronic / disabling mental health conditions)
    • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and chronic lung disorders)
  • Take at least eight or more prescription medications covered by Part D
  • Expect to spend more than $1,623 in 2025 on prescription medicines covered by Medicare Part D

How to enroll

If you are eligible, you will be automatically enrolled in the program. Eligible members will receive a letter inviting them to schedule a medication review with a pharmacist.

You may return the participation form in the mail or call a toll-free phone number (866-686-2223 or TTY users call 711) between 10 AM and 6 PM Eastern Time, Monday through Friday (except major holidays).

Participation in the program is voluntary.

Members may opt out from participating in the program.

This can be done by calling the telephone number listed in the notification letter (866-484-3953 or TTY users call 711) 24 hours a day, 7 days a week. When prompted, enter your opt-out personal security PIN.

You may refuse individual services without having to opt out from the whole program.

Learn more about the program

 

Members should refer to their Evidence of Coverage for more details on the MTM Program. This program is not considered a benefit and is offered at no cost to eligible members.