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. MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.
What is the Medication Therapy Management (MTM) program?
The MTM program is a service offered by Navitus MedicareRx at no additional cost to you. It is required by the Centers for Medicare and Medicaid Services (CMS). It is not part of your pharmacy benefit.
How do I participate in this program?
To participate, you must meet certain criteria. These are used to identify people who have many chronic diseases and are at risk for related problems. If you meet these criteria, we will send you a letter inviting you to take part in the program. We will also send you information and provide instructions to access the program. Your enrollment in MTM is voluntary. It does not affect Medicare coverage for drugs covered under Medicare.
To qualify for Navitus MedicareRx’s MTM program, you must meet the requirements for at least one of the following two groups:
1. Have at least three of the following conditions or diseases:
- Diabetes
- Dyslipidemia
- Hypertension
- Depression
- Asthma
- HIV/AIDS
AND
Take at least eight covered Medicare Part D medications.
AND
Are likely to have greater than $4,935 per year in covered Medicare Part D medication costs.
OR
2. Are enrolled in the Navitus MedicareRx Drug Management Program. This program helps our members safely use their prescription opioid medications, and other medications that are frequently abused.
What services does the MTM program offer?
To help reduce the risk of possible problems, our MTM program offers two types of clinical review:
- Targeted medication review: At least every three months, we will review all of your prescription medications and may contact your doctor if we detect a potential problem.
-
Comprehensive medication review (CMR): At least once per year, we offer a free discussion and review of all of your medications by a clinician or other health professional to help you use your medications safely. This service is provided to you confidentially on behalf of Navitus MedicareRx 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. Open a blank version of the TDL form.
- Personal Medication List (PML): The PML will help you and your health care providers keep track of your medications. It explains how to use your medications the right way. Open a blank version of the PML form.
Next Steps
If you take many medications and have three or more chronic health conditions, please contact us to see if you're eligible. You can call the Navitus Medication Therapy Management (MTM) program team at 1-888-913-7885, Monday through Thursday 8 a.m. to 7 p.m. Central Time and on Friday 8 a.m. to 5 p.m. Central Time. TTY users can reach our program team through the National Relay Service 711, during the same hours as shown above.