Medication Therapy Management Program

2026 Medication Therapy Management Program

If you’re in a Medicare drug plan and have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Prominence Health Plan at no additional cost to you. The MTM program is required by the Centers for Medicare & Medicaid Services (CMS) for all Medicare Part D plans and is not considered an additional benefit. This program helps you and your doctor make sure your medications are working and helps identify and resolve possible medication problems.

Program Criteria

To qualify for Prominence Health Plan’s MTM program in Florida, Nevada and Texas, you must meet all the following criteria established by CMS. These criteria are used to identify people who have multiple chronic diseases, are likely to have high drug costs, and may be at risk for medication-related problems.

1. Have at least three of the following 10 core chronic diseases:

• • Alzheimer’s Disease
  • Bone disease/arthritis (e.g., osteoporosis, osteoarthritis, 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 conditions (e.g., depression, schizophrenia, bipolar disorder, or other chronic/disabling mental health conditions)
  • Respiratory disease (e.g., asthma, COPD, other chronic lung disorders)

2. Take at least eight covered Part D maintenance drugs
3. Incur at least one-fourth of the annual MTM cost-threshold amount determined by CMS during the previous three months (for 2026, this threshold is $1,276; this value may change each year based on CMS updates)

You may also qualify if you are considered to be an at-risk beneficiary (ARB) as defined by CMS.

Participation in MTM is voluntary and does not affect your Medicare drug coverage.

Clinical Review of Medications

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical reviews:

• Targeted medication review (TMR) — Conducted at least quarterly to address specific or potential medication-related problems. Findings are assessed to determine whether follow-ups are necessary and any needed interventions are performed accordingly.
• Comprehensive medication review (CMR) — Conducted at least once per year. The CMR is an interactive, person-to-person consultation with a pharmacist or other qualified health professional to help you use your medications safely. This review is provided by Abarca Health on behalf of Prominence Health Plan and typically takes about 30 minutes. Afterward, you’ll receive a written summary that includes a Medication Action Plan (MAP) and a Personal Medication List (PML) to share with your providers. These documents will help you track your medications and take the best steps to achieve optimal results.Your CMR summary (MAP and PML) will be mailed to you within 14 days of your review.

Download a blank copy of the Personal Medication List (English)
Download a blank copy of the Personal Medication List (Spanish)

If you take many medications for more than one chronic health condition, contact your drug plan to see if you are eligible for MTM. For more information, please contact us at 1-866-508-2081, Monday through Friday from 8:00 a.m. – 5:00 p.m. TTY users please call 1-855-296-8965.