Medication Therapy Management Programs

Who Qualifies for Medicare’s Medication Therapy Management?

When you’re enrolled in a Medicare Advantage plan and take multiple prescription medications, there is a lot to manage. Are you paying too much? Do your medications have interactions? Are you keeping track of side effects?

If you qualify, a Medication Therapy Management (MTM) program may help. MTMs are required by the federal Centers for Medicare & Medicaid Services (CMS). It’s offered through Medicare Advantage plans, like Prominence, as part of Part D prescription drug coverage. While not considered a benefit, these programs are free and can offer members valuable assistance.

How to manage your medication therapy from Medicare

CMS created specific criteria members must meet to gain eligibility for an MTM program. If you have a Medicare Advantage plan with Part D, you may qualify if you:

• Take eight or more long-term medications covered under Medicare Part D
• Spend at least the amount capped by CMS. This amount may change annually.

If you qualify, you’ll be automatically enrolled. Your Medicare Advantage plan will send a letter to schedule your free medication review. You may also be a candidate for drug coverage and medication management if you suffer from three or more chronic conditions:

• Alzheimer’s
• Arthritis or bone disease (osteoporosis)
• Chronic heart failure
• Diabetes
• High cholesterol
• End-stage kidney disease
• HIV/AIDS
• High blood pressure
• Mental health conditions (bipolar disorder, schizophrenia)
• Chronic lung disease (asthma, COPD)

Medicare Advantage Part D and medication therapy

The main goal and purpose of an MTM program is to help ensure your medications are effective, safe and affordable. When you take several medications, they may be prescribed by different healthcare providers. That’s why members in these programs meet with a pharmacist or trained provider to review their medications, one-on-one.

MTM members annually receive a private medication appointment which may include:

• A trained provider appointment for your questions
• Close review of all the medications you’re taking
• Check for possible drug interactions or safety concerns
• Answer questions about your medications
• Suggest lower-cost alternatives (including generic drugs)
• Help you stay organized with your medications

At least quarterly, the MTM program conducts Targeted Medication Reviews to evaluate your medications. If any issues arise, your Medicare Advantage plan will contact you and/or your doctor.

Your health matters. MTM programs are designed to help you stay safe, informed and in control of your medications — at no extra cost.

Enroll now

Call 866-747-8855 to join a Prominence Medicare Advantage plan during an enrollment period. The provider network presently offers members access to quality medical services in Florida, Nevada and Texas.

Enroll online

* All benefits not available on all plans

Additional resources from Prominence Medicare

Prominence Medicare Guide to Prescription Drug Coverage

A New Way to Manage Your Part D Costs (PDF guide)

Prominence Medicare Provider and Pharmacy Directories