Medication Therapy Management (MTM) Program
If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program at no additional cost to you.
What is the MTM Program?
The MTM program is a 1-on-1 review with a pharmacist or other trained health care professional to help Medicare members better manage their medications, long-term chronic health conditions, and promote safe and effective medication use.
The MTM program helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems, find lower cost options to your current medications, and helps answer questions or concerns you may have about your medications.
The MTM program is not part of your prescription drug benefit. It is a Centers for Medicare and Medicaid Services (CMS) designed program offered by Peak Advantage to our members who are enrolled in our Medicare Part D prescription drug plans. The MTM program is a service offered at no additional cost to you.
How do I participate?
Peak Advantage determines eligibility quarterly by looking at your medication claims information. If you meet the below eligibility requirements, then you’ll be enrolled in the MTM program automatically. If you do not want to participate in the program, then you can choose to opt out at any time.
Peak Advantage MTM Program 2027 Eligibility Criteria
You have three or more of the following chronic disease (based on claims data):
✓ Alzheimer’s Disease
✓ Bone disease including osteoporosis, osteoarthritis, and rheumatoid arthritis
✓ Chronic Congestive heart failure (CHF)
✓ Diabetes
✓ Dyslipidemia (high cholesterol)
✓ End-stage renal disease (ESRD)
✓ Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
✓ Hypertension (high blood pressure)
✓ Mental Health Condition (bipolar dipolar disorder, depression, schizophrenia, and other chronic/disabling mental health conditions
✓ Respiratory disease (asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
AND you have 8 or more maintenance Part D covered drugs
AND are likely to incur annual costs that meet or exceed $1,340 for all covered Part D drugs
You may also be enrolled in the Medication Therapy Management program if you have been identified as an At-Risk Beneficiary (ARB) in our Drug Management Program.
1- 888-913-7885 (TTY: 711)
Monday – Thursday: 9 a.m. – 8 p.m., Friday: 9 a.m. – 6 p.m.
If you take many medications and have three or more chronic health conditions, please contact the Navitus Medication Therapy Management (MTM) Program Team to see if you’re eligible.
If you are eligible, we will send you a letter inviting you to participate in the program. We will also send you information and provide instructions to access the program.
What services does the MTM program offer?
The MTM program provides an extra layer of support by assigning a pharmacist or health care professional to work directly with you to help ensure that your prescriptions are safe and effective. The MTM program offers two types of clinical review:
Targeted Medication Review:
At least every three months, we will review all your prescription medications and may contact your doctor if we detect a potential problem. Targeted medication reviews look for drug-therapy problems, such as drug-drug interactions, high doses, duplications in therapy, and gaps in care (care you should have gotten but did not).
Comprehensive Medication Review (CMR):
At least once per year, we offer a free discussion and review of all your medications (including prescription, over-the-counter medications, and herbal supplements) by a pharmacist or other health care professional to help you use your medications safely. This service is provided to you confidentially on behalf of Peak Advantage via telephone by our Clinical Engagement Center’s clinician. The CMR may also be provided in person at your provider’s office, pharmacy, or long-term care facility.
The process takes about 20-30 minutes of your time. Afterwards you will receive a written summary of the CMR, which can be helpful when you talk with your doctors. It includes:
✓ Recommended To-Do-List (TDL) (also known as Medication Action Plan (MAP)): The TDL has steps you should take to help you get the best results from your medications.
✓ Medication List: The Medication List will help you and your health care providers keep track of your medications. It explains how to use your medications the right way.
Additional Benefits
Medication Therapy Management (MTM) Program
Learn more about the Medication Therapy Management program.
Medication Action Plan (MAP)
Keep track of what you discussed with your provider and the steps you should take next.
Personal Medication Worksheet
Keep an up-to-date list of your medications and how you take them.