How to Know if You're Eligible for a Medication Therapy Management Program

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Living with chronic conditions can be hard, especially if you factor in all of the medications you have to take on a daily basis. With Medicare Part D plans that include Medication Therapy Management, you can get help sorting out your medications for free so you can better manage your chronic conditions and improve your overall health. If you've been struggling to manage your conditions or your medication, it might be time to consider Medication Therapy Management. Here you'll find all the information and resources you need to decide whether this type of program is right for you and determine if you're eligible.

What is the Medication Therapy (MTM) Program? 

The Medication Therapy Management (MTM) Program is a free program available through all Part D plans to certain members who have multiple chronic conditions, take multiple medications, and are at risk for spending more on annual Part D covered drug costs than a certain cost threshold. The purpose of the program is to help you and your doctor ensure that your medications are working properly to improve your health. It's also meant to reduce the risk of adverse events from taking different medications that treat different health conditions. Many medications can often interact with one another, which is why it's important that you get the counseling you need to ensure you're taking each medication safely and effectively.

If you're eligible, you'll get a Comprehensive Medication Therapy review (MTR), a personal medication record (PMR), a medication-related action plan (MAP), an intervention and/or referral, and a documentation and follow-up. You can use all of that information to keep track of your prescription medications. The PMR is a handy little list that you can take to all of your doctor's visits so that when asked what medications you're taking, you don't have to try and remember from memory. Once every three months, you'll get a review of your medications.

How to Know if You're Eligible 

Medicare Parts A and B are available through the federal government while Medicare Part C is available from private, Medicare-approved insurance companies such as Anthem. To qualify for Anthem's Medication Therapy Management Program, you have to be managing more than one chronic health condition or take eight or more daily prescription medications. You could also qualify if you spend a certain amount per year (indicated by CMS) on Part D covered medications.

If you have three or more of the following chronic health conditions, you'll qualify for the MTM program:

  • Diabetes 
  • Bone Disease Arthritis (i.e., Rheumatoid Arthritis, Osteoporosis, Osteoarthritis) 
  • Chronic Heart Failure (CHF) 
  • High blood pressure (hypertension) 
  • Dyslipidemia (abnormal amount of lipids, such as fat or cholesterol in the blood) 
  • Alzheimer's disease 
  • Mental health disorders (bipolar disorder, depression, schizophrenia, chronic or disabling disorder) 
  • Respiratory disease (COPD, chronic obstructive pulmonary disease, asthma, or chronic lung disorder) 

If you take eight or more daily medicines covered by Medicare Part D or you're spending $4,255 or more in 2020, you might also qualify. Learn more about the Medication Therapy Management Program if you're eligible so you can get the help you need at no extra cost.

Getting the Help You Need 

With the assistance of a Medication Therapy Management Program, you can get help managing your medications more efficiently to make managing your chronic conditions easier and more effective. Living with multiple chronic conditions is hard enough without trying to manage your medications on your own and paying more than you can afford. Get the help you need by comparing Part D plans that offer Medication Therapy Management.

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