Skip Ribbon Commands
Skip to main content

Medication Therapy Management Program

What is a Medication Therapy Management (MTM) Program?

If you’re in a Medicare drug plan and take medications for different medical conditions, you may be eligible to get services, at no cost to you, through a Medication Therapy Management (MTM) program. This program helps you and your doctor make sure that your medications are working to improve your health. A pharmacist will provide a comprehensive review of all your medications and talk with you about:
  • How to get the most benefit from the drugs you take
  • Any concerns you have, like medication costs and drug reactions
  • How best to take your medications
  • Any questions or problems you have about your prescription and over-the-counter medication

What to Expect:

A Medication Therapy Management (MTM) Program is a free service offered to eligible members of KelseyCare Advantage drug plans. You may be invited to participate in this program designed for your specific health and pharmacy needs. An initial program offer letter will be mailed to your home to welcome you to the Medication Therapy Management (MTM) Program. A representative from KelseyCare Advantage will call you to ask you to participate in a comprehensive medication review with a health plan pharmacist. All medication reviews will be completed over the phone in the privacy of your own home. The review is designed to give you one-on-one time with a pharmacist who is knowledgeable in your Part D benefits and coordinate care with your physician. Typically, a medication review lasts anywhere from 20 to 40 minutes. After the medication review, you will receive a written summary of the discussion, including a medication action plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions. You’ll also get a personal medication record that will include all the medications you’re taking and why you take them. These documents can be shared with your doctors or other health care providers. The Medication Therapy Management (MTM) Program will continue to review your medications each quarter to make sure you are still getting the most benefit from your medications. You may decide not to participate but it is recommended that you take full advantage of this complimentary service if you are selected. Please note that not all plan members will qualify for the program, therefore the program is not considered a benefit.

To qualify for this program you are required to meet the following CMS directed MTM Criteria:

  • Have any three of the following chronic diseases: Alzheimer’s disease; Chronic heart failure (CHF); Diabetes; Hepatitis C; HIV/AIDS; Multiple Sclerosis; Respiratory Diseases such as Asthma, Chronic Lung Disorders, or Chronic Obstructive Pulmonary Disease (COPD); or Bone Diseases such as Osteoarthritis, Osteoporosis, or Rheumatoid Arthritis
  • Take eight or more Part D medications
  • Spend an expected total of more than $4,255.00 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)

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
The MTM program aims to help you get the best benefits from your medications. To review and/or print a sample of  MTM service documents, download a blank copy of the Medication Action Plan and Personal Medication Record.

If you have any questions, please contact Member Services:

713-442-2273 or toll free 1-866-535-8343
TTY/TDD: 866-302-9336

Hours of Operation: 8:00 a.m. – 8:00 p.m., seven days a week (October 1 – March 31), 8:00 a.m. to 8:00 p.m., Monday through Friday (April 1 – September 30).