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Medicare Medication Therapy Management (MTM) Program

What is the Medication Therapy Management (MTM) Program?

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

The MTM Program is offered through our partnership with OutcomesMTM. The MTM program is not considered a part of the plan’s benefit.

How to Qualify for the Program

To qualify for the MTM program, you must meet the eligibility requirements. First, this program is specific to Medicare members who have Part D coverage through BlueCross BlueShield of Western New York, a Medicare Advantage Plan that includes Prescription Drug coverage (MAPD), or a 'standalone' Medicare Part D Plan or Prescription Drug Plan (PDP). Medicare Advantage members who have Part B coverage only would not be eligible to enroll in the program. You may qualify if you suffer from 3 or more chronic health conditions, such as the following listed below. If you qualify, you will be auto-entered 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. 

  • Asthma
  • Chronic Heart Failure (CHF)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Depression
  • Bipolar Disorder
  • Diabetes
  • End-Stage Renal Disease (ESRD)
  • High blood fat levels
  • High blood pressure
  • Osteoporosis
  • You take 8 or more chronic/maintenance medications daily, covered by Medicare Part D
  • You incur one-fourth of the specified annual cost threshold ($4,255 per year or $1,064 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 opportunity to speak with a highly trained pharmacist. During that call, the pharmacist will complete a comprehensive review of your medications and will speak with you about:

  • Any questions or concerns about your prescription or over-the-counter medications, such as drug safety and costs
  • Helping you better understand your medicines and how to take them
  • How to get the most benefit from your medications
     

What You Can Expect to Receive

If you qualify for the medication management program, you will receive the following: 

  •  A welcome letter that will explain how to get started within 60 days which will provide an explanation of the program, instructions to opt out of the program if the member so chooses, and offers the opportunity to request a comprehensive review (CMR). 
  • The member can request a CMR by returning an enclosed appointment form or calling the toll-free number included in the introductory letter. Members that request a CMR have a telephone appointment scheduled for a one-on-one consultation with a qualified MTM provider.
  • A full medication review - You will have the chance to review your medicines with a highly-trained pharmacist. This review will take approximately 20-30 minutes over the phone. During this call, any issues with your medications will be discussed. The call will be scheduled at a time that is most convenient for you.
  • After you complete the full medication review, a summary will be mailed to you. The summary includes a medication action plan. 
  • Ongoing medication reviews - At least once every three months, your medications will be reviewed, and you or your doctor will be contacted if changes to your medicine(s) are needed. You may get notified by mail or phone for this review. 

Medicare Questions?

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1-833-735-4511 (TTY 711)
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Jan. 1 - Sept. 30, 8 a.m. to 8 p.m., Monday - Friday

BlueCross BlueShield of Western New York (BCBSWNY) is a division of HealthNow New York Inc., an independent licensee of the Blue Cross and Blue Shield Association. BCBSWNY 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 linguistica, Llame al 1-833-735-4515 (TTY 711) 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY 711) 

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Content Last Updated: January 14, 2020