How do you qualify for the MTM Program?

To participate in the MTM Program, you must be eligible. If you qualify, we will automatically enroll you at no additional cost. We will mail you a letter and may follow up with a phone call and/or a text message inviting you to participate and providing information about the program. Participation is voluntary. You can opt out of the program at any time, but we hope you can take advantage of this opportunity to get the most from your medications.

There is no added cost for this program. While not considered a Medicare benefit, the MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is a special service part of your Medicare plan. The goal is to help you get the maximum benefit from your medications.

For EmblemHealth VIP Medicare Advantage Prescription Drug Plans:

To find out more about the MTM Program, you can call EmblemHealth Pharmacy Services toll-free at 888-447-0321 (TTY:711), Monday to Friday, 9 am to 5 pm.


For EmblemHealth VIP Prescription Drug Plans

This program is offered through our partnership with Express Scripts, Inc. (ESI) and  OutcomesMTMTM, a Cardinal Health company. Our MTM vendor,  OutcomesMTMTM, will contact you if you’re eligible.

To find out more about the MTM Program, you can call OutcomesMTMTM toll free at 855-723-7009 (TTY: 711), Monday to Friday, 9 am to 7 pm EST.

Who is eligible for the 2024 MTM Program?

For EmblemHealth VIP Medicare Advantage Prescription Drug Plans:

To be eligible, you must meet the criteria of at least one of the following two groups (1) and/or (2).

    1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D
    2. You have at least three of the following conditions:
      1. Chronic Heart Failure (CHF)
      2. Diabetes
      3. Hypertension (high blood pressure)
      4. Dyslipidemia (high cholesterol)
      5. Osteoporosis
    3. You must be likely to spend $5,330 or more in 2024 on prescription medications covered by Medicare Part D
  2. You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid (CMS) guidelines.

For EmblemHealth Prescription Drug Plans for Group Retirees:

To be eligible, they must meet the criteria of at least one of the following two groups (1) and/or (2).

    1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D
    2. You have at least three of the following conditions:
      1. Asthma
      2. Chronic Obstructive Pulmonary Disease (COPD)
      3. Chronic Heart Failure (CHF)
      4. Diabetes
      5. Hypertension (high blood pressure)
      6. Dyslipidemia (high cholesterol)
      7. Depression
      8. End-Stage Renal Disease (ESRD)
      9. Osteoporosis
    3. You must be likely to spend $5,330 or more in 2024 on prescription medications covered by Medicare Part D
  2. You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid Services (CMS) guidelines.

What will you get if you are eligible for the program?

You will:

  • Receive a welcome letter in the mail and may receive a phone call and/or text from us with information on how to get started.
  • Be invited to complete a full medication review with an EmblemHealth clinical pharmacist over the phone. During this review, the pharmacist will go over your medications including prescriptions, over-the-counter drugs, herbal therapies, and dietary supplements to make sure they are safe and working for you. The review may take up to 15 to 20 minutes.
  • Receive a personal medication list and medication action plan in the mail. Your personal medication list will help you keep track of your medications and how to use them the right way. Your medication action plan will have steps to help you get the best results from your medications. Be sure to share this information with your doctor.
  • Your medications can be reviewed every four months via a targeted medication review. After each review, we may send your doctor a letter explaining any issues or ways to improve. Your prescriptions will not change unless you and your doctor decide to change them.
  • Get helpful information on how to safely dispose of prescription drugs that are controlled substances, including opioids, at home and through takeback programs.

You and your health care providers can also keep track of the medications you are taking with a blank Personal Medication List

We want to be sure you understand your medications and how to take them. We will answer any questions or concerns you may have.

How do I schedule an appointment with a pharmacist?

If you are eligible for the MTM program, schedule an appointment to speak with one of our pharmacists.