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Medicare

Medication therapy management program

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

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.

1. Individual members eligible for the MTM Program services must meet all 3 criteria below:

  • Have at least 3 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 8 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

and / or

2. Have an active coverage limitation for an opioid or frequently abused medicine as a result of a Drug Management Program.

The MTM Program services include the following interventions for members and prescribers:

  • An annual comprehensive medication review (CMR) with a pharmacist to go over prescription and non-prescription medications that you take.
  • 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.

A Comprehensive Medication Review (CMR) is a person-to-person review of your medications with a pharmacist or nurse. 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

  • 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.

  • Educate members regarding their medications
  • Increase understanding about how to take medications as prescribed
  • Identify and prevent medical complications related to medication therapy

For more information regarding the MTM Program and a sample of a Personal Medication list from a CMR, please click on the following:

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.