Medication Therapy Management

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Medication Therapy Management (MTM) Program

The Medication Therapy Management (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 certain 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. It can also help prevent any issues with your medications.

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 at no additional cost. We will mail you a letter and follow up with a phone call 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 a special service part of your Medicare plan. The goal is to help you get the most 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 MedWiseRx. Our MTM vendor, MedWiseRx, will contact you if you’re eligible.

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

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 seven 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. Osteoporosis
    3. You must be likely to spend $4,696 or more in 2022 on prescription medications covered by Medicare Part D
  1. 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 $4,696 or more in 2022 on prescription medications covered by Medicare Part D
  1. You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid Services (CMS) guidelines.

If you are eligible you will:

  • Receive a welcome letter in the mail 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 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.

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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.

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YOUR MEDICATION

Delivery and Refills

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

MTM PROGRAM

KNOW YOUR RIGHTS

Grievances and Appeals

Find out how to file a grievance or an appeal, request coverage decisions and determinations, and more.

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.

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Last Updated 10/01/2021

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