Skip to main content
Shop Plans Learn more about our coverage options including health, Medicare, dental and vision options for you, your family or your employees. Get Started Individual & Family Medicare Employer Vision Dental International Travel Find Care FAQ Blog Members Stay on top of your health care with helpful member resources. Members Home Medicare Health Dental Vision Find Care Member Knowledge Center Member Forms Medicare Forms Library Make a Payment Federal Employees Student Blue Healthy Blue Providers Access tools, policies and the latest information to help you care for our members. Providers Home Network Participation Networks & Programs Claims, Appeals & Inquiries Prior Authorization Services & CPT codes Prescription Drug Search Policies, Guidelines & Codes Provider News Provider FAQ Contact Us Employers Learn about our coverage options for small and large employers, and access tools and resources for your group. Employers Home Shop Employer Plans Employer Portal Support Member Forms & Resources Find Care Blog Agents Access the tools you need: rate quotes, applications, forms, the latest industry news, marketing materials and more. Agents Home Agent Services Check Eligibility Find Care Member Forms & Resources Medicare Forms Library
Contact Us
Español
Log In
I am ... Please select A member A provider An employer An agent
Log in to Agent Services
Log in to Employer Services Register for Employer Services I'm registered but need portal access
Username Forgot username? Continue to Log In Register for Blue Connect Need help? Learn how to log in.
Log in to Blue e Register for Blue e Log in to Dental Blue
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.

Policies & Best Practices Fraud & Abuse Report Form Medicare Complaint Form Accessibility