Medication Therapy Management

EmblemHealth Medication Therapy Management (MTM) Program

The MTM Program is a free service for EmblemHealth Medicare plan members with a Part D prescription drug coverage who have certain health conditions and who take a certain number of prescription medications covered by Medicare Part D. The MTM Program helps you and your doctor make sure that your medications are working to improve your health.

If you qualify for the MTM Program, a pharmacist can review your prescription and over-the-counter medications and medical conditions. During the review, the pharmacist will talk to you about: 

  • Better understanding your medications, how to take them, and any side effects or reactions
  • Possible ways to save money on your medications   
  • Any questions or concerns you have

To participate in the MTM Program, you must be eligible. If you qualify, we will automatically enroll you and mail you a letter confirming your enrollment in our MTM program. You will also get a call from us. Participation is voluntary. You can opt out of the program at any time.

There is no extra cost for this program. While not considered a Medicare benefit, the MTM program is a special service part of your Medicare plan.

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 1-888-447-0321 (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 SinfoníaRx. Our MTM vendor, SinfoníaRx, will contact you if you’re eligible.

To find out more about the MTM Program, you can call SinfoníaRx toll free at 1-844-866-3730 (TTY: 1-800-367-8939), Monday to Friday, 10 am to 8 pm

For EmblemHealth VIP Medicare Advantage Prescription Drug Plans: 

You are eligible for the MTM Program if you take seven or more prescription medications covered by Medicare Part D and have at least three of the following conditions:

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • Chronic Heart Failure (CHF)
  • Dyslipidemia (high cholesterol)
  • Rheumatoid Arthritis
  • Osteoporosis

For EmblemHealth VIP Prescription Drug Plans (PDP):

To be eligible for the MTM Program, you must take eight or more prescription medications covered by Medicare Part D and have at least three of the following conditions:

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic heart failure (CHF)
  • Diabetes
  • Hypertension (high blood pressure)
  • Dyslipidemia (high cholesterol)
  • Depression
  • End-Stage Renal Disease (ESRD)
  • Bone Disease-Osteoporosis

For both drug plans, you must also be likely to spend $4,255 or more in 2020 on prescription medications covered by Medicare Part D.

For EmblemHealth VIP Medicare Advantage Prescription Drug Plans: 

You are eligible for the MTM Program if you take seven or more prescription medications covered by Medicare Part D and have at least three of the following conditions:

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Diabetes
  • Chronic Heart Failure (CHF)
  • Dyslipidemia (high cholesterol)
  • Rheumatoid Arthritis
  • Osteoporosis

For EmblemHealth VIP Prescription Drug Plans (PDP):

To be eligible for the MTM Program, you must take eight or more prescription medications covered by Medicare Part D and have at least three of the following conditions:

  • Asthma
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Chronic heart failure (CHF)
  •  Diabetes
  • Hypertension (high blood pressure)
  • Dyslipidemia (high cholesterol)
  • Depression
  • End-Stage Renal Disease (ESRD)
  • Bone Disease-Osteoporosis

For both drug plans, you must also be likely to spend $4,376 or more in 2021 on prescription medications covered by Medicare Part D.

If you are eligible you will:

  • Receive a welcome letter and a phone call 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 30 minutes.

  • Receive a personal medication list, in the mail. Your personal medication list will include information on all the medications you take. You will also receive a medication action plan. Be sure to share this information with your doctor.

  • Your medications can be reviewed every four months. 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.

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

MY COVERAGE

Drugs Covered

At EmblemHealth, we offer Medicare plans that cover a wide range of prescription drugs. For your convenience, there is a complete list of all covered drugs in our comprehensive formularies.

YOUR MEDICATION

Delivery and Refills

Find out how to set up home delivery or a get a prescription refill.

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Medicare Pharmacy

Additional Information

Learn more about what our over-the-counter debit card covers, how to get money back for a drug and more.

Last Updated 10/01/2020

Y0026_ 200570 Accepted 9/29/20