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Medication Therapy Management (MTM) program

In collaboration with PerformRx, we offer a Medication Therapy Management (MTM) program to ensure that you receive the most effective medications. MTM also helps to reduce the risk of side effects and interactions and lower your out-of-pocket costs. Your plan pays for the program, at no cost to you. This program is not considered a benefit. MTM does not change your insurance benefits, copayments, prescription coverage, or available doctors or pharmacies. Specially trained pharmacists will work closely with you and your doctors to solve any problems related to your medications and to help you get the best results.

Who is eligible for the MTM program in 2025?

The MTM program is designed to help you get the most from your medications if you meet all the following criteria:

  • You have three or more chronic diseases, including:
    • 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 other chronic/disabling mental health conditions)
    • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)

And

  • You take eight or more maintenance medications for chronic conditions.
  • You spend $1,623 or more per year on Medicare Part D covered medications.

Or

  • You have an active coverage limitation under a Drug Management Program for opioid use.

What happens if you qualify for the program?

1. You will receive an introduction letter that describes the program to you.

2. Comprehensive medication review (CMR): You will receive a CMR:

  • CMRs can be completed by phone generally in 30 minutes or less.
  • During this call a pharmacist (or other healthcare provider) will create, review, and mail a list of all medications including those prescribed by your doctor, over-the-counter medications, and vitamins/supplements. This review can help members understand their medications, address medication questions/concerns, identify harmful drug interactions or combinations, and potentially assist with coverage.
  • Following the consultation, you will receive a summary of your comprehensive medication review. The summary will contain a medication action plan for you to take notes or write down any follow-up questions.
  • Target Medication Review (TMR): At least quarterly, a TMR will be conducted. These reviews are more limited in scope and generally are used to find drug interactions or other potential concerns with medications. If necessary, information regarding these reviews will be sent to your doctor to evaluate.

3. Your medications will be reviewed on an ongoing basis.

  • A comprehensive medication review will be offered once a year.
  • At least every three months, your medicines will be reviewed, and your MTM pharmacist will work with you and your doctor(s) if any changes are needed.

Medicare requires that MTM programs automatically enroll those who qualify throughout the calendar year, but participation is voluntary, and you may opt out at any time. Once you are enrolled, you will remain enrolled through the calendar year unless you opt out or leave our plan.

To learn more, or to obtain MTM documents (including a Mediation List), please call PerformRx at 1-888-349-0501 (TTY/TDD: 1-888-765-6351) between 8:30 a.m. and 5 p.m. (EST), Monday through Friday.

A blank copy of the Personal Medication List may be found here. 

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Website last modified: 7/2/2025