Medication Therapy Management

MTM is a service offered at no additional cost to you. Although this program is not a plan benefit, we do recommend you take advantage of this free Medicare-designed program if you meet the eligibility requirements.

To take part in this program, you must meet certain criteria for multiple chronic conditions and/or be at risk for specific medication-related problems. To qualify for the DHMP MTM program, you must meet all the criteria from at least one of the following two groups:

Group A

• Are an Elevate Medicare Advantage member  
• Have at least two of the following conditions or diseases:
  • Chronic Heart Failure (CHF)
  • Diabetes 
  • Dyslipidemia
  • Hypertension
  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
• Take at least seven covered Part D medications
• Are likely to have medication costs of covered Part D medications equal to or greater than $5,330 per year

Group B

• Are an Elevate Medicare Advantage member 
• Are an at-risk beneficiary (ARB) with an active coverage limitation under DHMP's Drug Management Program (DMP)

This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems. 

If you meet criteria, you will automatically be enrolled. DHMP will send you a letter with information about the program and invite you to participate. Your participation in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

A TMR is a type of clinical review performed at least quarterly. For a TMR, we will review all your prescription medications, contact you by phone or mail and/or contact your doctor if we detect a potential problem.

A CMR is a type of clinical review performed at least once a year. A CMR is a free discussion and review of all your medications by a pharmacist or other health professional, to help you use your medications safely.

This review, or CMR, is provided to you confidentially in person or by telephone. The trained health professional conducting the review will check for drug safety problems and ways to save you money. This is also an opportunity to discuss any questions or concerns you have about your medicines.

This review typically requires 10-30 minutes of your time. You will get a written summary of the medication review, which you can take with you when you talk with your doctors. This summary includes:

• Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications.
• Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

You can download a blank copy of the Personal Medication List   to help you and your health care providers keep track of the medications you are taking.

If you think you might be eligible to participate in the MTM program or you want more information, please contact Health Plan Services at 1-877-956-2111. TTY users call 711. Our hours of operation are 8 a.m. – 8 p.m. seven days a week.