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  • Pharmacy Services > Medication Therapy Management Program

    EmblemHealth offers the Medication Therapy Management (MTM) program to EmblemHealth Medicare members who meet all of the following criteria:

    • Take seven or more chronic medications
    • Have high medication costs
    • Have at least three of the five conditions:
      • Rheumatoid arthritis
      • Chronic heart failure
      • Chronic obstructive pulmonary disease (COPD)
      • Diabetes
      • High cholesterol

      How the Program Works

      The MTM program helps EmblemHealth Medicare members better manage their conditions by providing a telephonic medication review as follows:

      • A pharmacist will review the member's prescription medicines, over-the-counter drugs and any herbal supplements to ensure they are safe and working.
      • A personal medication list will be mailed to the member after the call. The personal medication list includes all medicine the member is taking and explains how and why the medication is taken. The member will also receive a medication action plan to remind the member what was talked about during the call and what the member needs to do.
      • The member will receive educational material on his or her chronic condition.
      • A pharmacist will answer any questions or concerns the member has about his or her medications.
      • A pharmacist will monitor the member's progress and may provide drug alerts or recommendations to the practitioner to optimize therapy.

        For more information about the MTM program, call 1-888-447-0321, Monday through Friday, from 9 am to 5 pm.

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        Glossary terms found on this page:

        An activity of EmblemHealth or its subcontractor that results in:

        • Denial or limited authorization of a service authorization request, including the type or level of service
        • Reduction, suspension or termination of a previously authorized service
        • Denial, in whole or in part, of payment for a service
        • Failure to provide services in a timely manner
        • Failure of EmblemHealth to act within the time frames for resolution and notification of determinations regarding complaints, action appeals and complaint appeals

        Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

        A nationwide insurance program for the disabled and people age 65 and over, created by the 1965 amendments to the Social Security Act and operated under the provisions of the Act. It consists of two separate but coordinated programs, Part A and Part B.

        An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

        A written order or refill notice issued by a licensed medical professional for drugs available only through a pharmacy.


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