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Medication Therapy Management Program

What is a Medication Therapy Management (MTM) Program

The Medication Therapy Management (MTM) program can help our members with complex health needs. For example, members who have several medical conditions, take different medications at the same time, or have high drug costs. This program is voluntary and free to eligible members and does not affect your coverage. This program is open only to those invited to participate. The program is not a benefit for all members.

What Should I Expect?

After receiving and accepting an invitation by mail from KelseyCare Advantage to participate in the MTM program

  • A KelseyCare Advantage representative will call you to set up a one-on-one review with a health plan pharmacist who is knowledgeable about your Part D benefits
  • All medication reviews are typically 30 minutes and are completed over the phone in the privacy of your own home
  • The pharmacist will coordinate and collaborate with your physician on your medication plan
  • After the medication review, you’ll receive a written summary of the discussion, including a medication action plan with recommendations
  • You’ll also get a personal medication record that will include all the medications you’re taking and why you take them, which you can share with your healthcare providers
  • The medication reviews will continue each quarter to make sure you’re still getting the most benefit from your medications

How Will I Qualify?

To qualify for this program, you are required to meet one of the following CMS directed MTM Criteria:
1. Have any three of the following chronic diseases:

  • Alzheimer’s disease
  • Chronic heart failure (CHF)
  • Diabetes
  • Hepatitis C
  • Multiple sclerosis
  • Respiratory diseases such as asthma, chronic lung disorders, or chronic obstructive pulmonary disease (COPD)
  • Bone diseases such as osteoarthritis, osteoporosis, or rheumatoid arthritis

2. Take eight or more Part D (prescription) medications

3. Spend an expected total of more than $4,935 in 2023 per year for Part D medications (the expected total is the amount paid by the plan for Part D medications, added to the amount the member pays)

Included Services

The MTM program provides a broad range of services, including but not limited to:

  • Conducting patient assessment and/or a comprehensive medication review (CMR)
  • Formulating a medication action plan (MAP)
  • Developing a personalized medication record (PMR)
  • Monitoring efficacy and safety of medication therapy through targeted medication reviews (TMR)
  • Enhancing medication adherence
  • Coordinating care with your physicians

View and print samples of MTM service documents:

Sample Medication Action Plan and Personal Medication Record

Always at Your Service

Call Member Services at 713-442-CARE (2273)
or toll-free at 1-866-535-8343 (TTY: 711)

8 a.m.– 8 p.m. | 7 days a week | From October 1 to March 31

8 a.m.– 8 p.m. | Monday – Friday | From April 1 to September 30

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