Licensed Insurance Agents: 888-323-1149 TTY: 711
Mon - Fri, 8am - 8pm ET

Medicare’s Medication Therapy Management Program

October 6, 2016

If you’re a Medicare beneficiary with multiple health conditions that require a complex medication regime, it can be a challenge for you to make sure you’re taking your prescription drugs correctly. In some cases, Medicare offers assistance at no cost to help manage your medications with a program called Medication Therapy Management (MTM).

Under Medicare’s Medication Therapy Management program, a health-care provider, such as a pharmacist, reviews all of your medications. Then she or he creates a list of all your drugs and why you take each one, as well as a medication action plan that may include recommendations about how to take your prescription drugs.

If you qualify for the MTM program, you can set up an appointment for a medication review. During this review, the health-care provider will go over information with you including (but not necessarily limited to) these issues:

  • How to take your prescription drugs in ways that may help your conditions the most
  • Any questions you might have, such as drug reactions, costs, or other details

After the discussion, you will receive a written summary, including a plan that recommends what you can do to make the best use of your medications, with space for you to take notes or submit any follow-up questions, and a medication list that includes all the medications you’re taking and why you take them. You are encouraged to share this information with your doctor and keep you medication list with you if you see other doctors or go to the hospital.

To qualify for Medicare’s Medication Therapy Management program, all of the following need to be true for you:

  • You’re enrolled in a Medicare prescription drug program. This can be a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
  • You have more than one chronic illness or chronic health condition.
  • You take multiple prescription drugs for those conditions.
  • The total cost of your medications is more than a certain amount per year. This amount may change from year to year; check with your Medicare plan providing prescription drug coverage for more information.

Medicare plans providing prescription drug coverage may be provided if you to have two or three chronic illnesses to qualify for an MTM program, but they can’t require you to have any more than three chronic diseases to participate in the program. And your plan can limit participation in the program to those who take anywhere between two and eight different medications, but it can’t require you to take more than eight drugs.

Medicare plans providing prescription drug coverage have a certain amount of flexibility in deciding which chronic conditions qualify for an MTM program, but there are some restrictions. A plan may choose to allow any chronic health conditions to qualify for the program, or the plan may decide to restrict the program to certain health conditions. If the plan limits the program to certain health conditions, the list must include at least five of these nine “core” chronic conditions specified by the Centers for Medicare and Medicaid Services:

  • Alzheimer’s disease
  • Bone-disease arthritis
  • Certain respiratory diseases
  • Certain mental illnesses
  • Chronic heart failure
  • Diabetes
  • Dyslipidemia
  • End-stage renal disease
  • Hypertension

You might be automatically enrolled in the MTM program when you meet the criteria, but your participation is voluntary.

This information is provided for educational purposes only. It is not to be used for medical advice, diagnosis or treatment. Consult your doctor if you have questions or concerns.