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Therapy Management Program


Medication Therapy Management Program (MTM)




The Medication Therapy Management Program (MTM) is designed to help eligible members with multiple conditions reconcile their medication profile and identify and resolve any drug related problems in order to optimize therapeutic outcomes. MTM Program is individualized, voluntary and complimentary to the drug coverage. The benefits of the program include a complete evaluation of the drug therapy to ensure adequate and safe use of medications. This assessment comprehends education and recommendations to the member, as well as for the physician or other health care professionals. This program is not considered a benefit of the drug coverage, however it is offered at no additional cost to the member. 



MTM Program participation criteria:


Members will automatically enter the program if they meet the following three criteria:

•  Having incurred in expenses of Part D drug coverage, up to $991.75 in the last three months or $3,967.00 during the last 12 months, if they have at least three chronic conditions as listed above and are using at least eight drugs of the selected therapeutic classes. If the member does not want to participate in the program, they can choose not to participate.


•  Having at least three chronic conditions as listed below:
     1. Congestive Heart Failure (CHF)
     2. Diabetes
     3. High Cholesterol
     4. High Blood Pressure
     5. Chronic Obstructive Pulmonary Disease (COPD)
     6. Bone disease/ Rheumatoid Arthritis
     7. Bone disease/Arthritis: Osteoarthritis
     8. End Stage Renal Disease
     9. Asthma


•  Being using at least eight medications covered under Medicare Part D included in the following therapeutic classes:
     1. Drugs for high cholesterol

     2. Cardiovascular drugs
          a. Angiotensin Converting Enzyme Inhibitors (ACE)
          b. Angiotensin II Receptor Blockers (ARBs)
          c. Beta Blockers
          d. Diuretics
          e. Alpha-blockers
          f. Antiarrhythmics
          g. Digitalis glycosides
          h. Calcium Channel Blockers

     3. Asma/COPD drugs
          a. Inhaled corticosteroids
          b. Bronchodilators
          c. Leukotrienes

     4. Diabetes drugs
          a. Insulins
          b. Oral hypoglycemic

     5. Rheumatoid arthritis/osteoarthritis Drugs
          a. Narcotics
          b. Non-steroidal Anti-inflammatory Drugs
          c. Tumor Necrosis Factors (TNFs)




MTM Services and Materials


The services provided to the member enrolled in the program include:

  • Welcome Letter (through mail), explaining the program in detail.
  • Telephone call to schedule an appointment for a comprehensive medication review.
  • Annual comprehensive medication review (CMR) is made through a telephone call in order to identify potential drug therapy problems and create an action plan to resolve them. This phone call, either to member or authorized representative, is made by a nurse or pharmacist. The time of the call fluctuates from 20 to 30 minutes, depending on the member.
  • Follow up evaluations by a health care professional, including quarterly targeted medication reviews such as monitoring of medication utilization.
  • Consultations and interventions with prescribing physician and/or other health care professionals to optimize therapy and resolve any medication related issues. Referrals to other company programs will be offered, if necessary.
  • Member will receive, within 14 days after the interview, a summary of the interview that will include the updated patient medication list and the action plan to be taken regarding the member’s drug therapy.


Download a copy of the Personal Medication List.


For more information contact us at 787-523-2397 (Metro Area), 1-844-660-1660 (toll free), or at 1-866-333-5469 TTY (hearing impaired), Monday through Friday from 8:00 a.m. to 5:00 p.m.