Medication Therapy Management Plan

What is the Medication Therapy Management (MTM) Program?

The Medication Therapy Management (MTM) Program is a service for members with multiple health conditions and who take multiple medicines. The MTM program helps you and your doctor make sure that your medicines are working to improve your health.

To qualify for the MTM program, you must be eligible. Please see below for those details. If you qualify, you will be auto-enrolled into the program and the service is provided at no additional cost to you. You may choose not to participate in the program, but it is recommended that you make use of this free service.

The MTM Program is offered through our partnership with Express Scripts Inc. and SinfoniaRx and The Medication Management Center (MMC) at the University of Arizona. The MTM program is not considered a part of the plan’s benefit.

Who is eligible for the MTM Program?

You may qualify for the MTM Program if you suffer from 3 or more chronic health problems. These may include: 

  • Asthma
  • Chronic Heart Failure (CHF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic Respiratory Disease 
  • Depression
  • Diabetes
  • End-Stage Renal Disease (ESRD)
  • High blood fat levels
  • High blood pressure
  • Osteoporosis
  • You take 7 or more daily chronic/maintenance medicines covered by Medicare Part D
  • You incur one-fourth of the specified annual cost threshold ($3,967 in the previous three months). 

How does the MTM Program help you?

If you qualify for the MTM Program, you will be contacted and have the chance to speak with a highly-trained pharmacist or a pharmacist intern who is under the direct guidance of a pharmacist. During that call, the pharmacist or pharmacy intern will complete a comprehensive medication review of your medicines and talk with you about:

  • Any questions or concerns about your prescription or over-the-counter medicines, such as drug safety and cost
  • Better understanding your medicines and how to take them
  • How to get the most benefit from your medicines

What will you receive?
If you qualify for the MTM Program, you will receive: 

1. A Welcome letter that tells you how to get started.

2. A Full medication review:

  • You will have the chance to review your medicines with a highly-trained pharmacist or a pharmacist intern under the direct guidance of a pharmacist each year.  This review will take about 20-30 minutes. During this call any issues with your medicines will be discussed.  The call can be scheduled at a convenient time for you.
  • After you complete the full medication review, a summary is mailed to you. The summary includes a medication action plan with space for you to take notes or write down any follow-up questions.
  • You also will be mailed a personal medication list that lists all of the medicines that you take and the reasons why you take them.
  • Click here to see an example of the full medication review letter
    3. Ongoing targeted medication reviews:  
  • At least once every 3 months, your medicines will be reviewed, and you or your doctor will be contacted if you should think about any changes in your medicines.       
  • You may get a letter or a phone call for this review.



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This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.

Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of Western New York members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

BlueCross BlueShield of Western New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.

A division of HealthNow New York Inc., and independent licensee of the BlueCross BlueShield Association. A salesperson will be present with information and applications. For accommodations of persons with special needs at sales meetings, please call 1-800-329-2792 (TTY 711). BlueCross BlueShield of Western New York complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-329-2792 (TTY: 711).

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Y0086_MRK1961 Approved
Content Last Updated October 1, 2017