Medication Therapy Management | Blue Cross and Blue Shield of Texas

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Medication Therapy Management

The Medication Therapy Management (MTM) program reviews the medicines you take to make sure they’re safe, work well and fit your lifestyle. This program is offered at no additional cost to eligible members. This service is not considered a benefit.

The goal is to help you get the best results from your medicines, at the lowest possible price. The MTM program is right for you if you need answers to questions below:

  • Why am I taking these medicines?
  • Do over-the-counter products interact with my prescriptions?
  • Can I save money on my prescriptions?

The program can also help you and your doctor make sure that your medicines are the best choice for you.

MTM Eligibility

You're automatically enrolled in the MTM program if you meet the criteria listed below.

2018

1. Have 3 or more of the following conditions:

  • Chronic Heart Failure
  • Diabetes
  • High blood pressure
  • High blood cholesterol
  • Rheumatoid arthritis

AND

2. Take 8 or more prescription medications covered by Medicare Part D.
AND
3.    Expect to spend more than $3,967 in 2018 on prescription medicines covered by Medicare Part D.

2019

1. Have 3 or more of the following conditions:

  • Chronic Heart Failure
  • Diabetes
  • High blood cholesterol
  • High blood pressure
  • Rheumatoid arthritis

AND

2. Take 8 or more prescription medications covered by Medicare Part D.
AND
3.    Expect to spend more than $4,044 in 2019 on prescription medicines covered by Medicare Part D.

What You Can Expect

The MTM program is a two-part program. Reviews may be done over the phone, whenever it’s convenient for you. In some cases, you may have an in-person review.

Comprehensive Medication Review (CMR)

This personalized review lets you talk one-on-one with an MTM pharmacist.

To get ready for your review make a list of all the medicines you take. Write down even over-the-counter medicines or supplements. Include how much you take each day and how often you take them. The pharmacist will review your list and talk about it with you. This usually takes about 30 minutes.

After your review, you’ll get a complete list of your medicines and an action plan that you can bring with you to your next doctor’s visit. Download a personal medication list.

Targeted Medication Review (TMR)

Every few months, the program reviews your prescription claims to make sure there are no issues that need attention. If the review identifies any issues, we may contact your doctor.

Get Started

If you’re eligible for MTM, you’re automatically enrolled. You’ll get a letter or phone call letting you know how to schedule an appointment or opt out of the program.

Opting Out

Medicare requires us to automatically enroll you if you’re eligible. But, this service is voluntary — you’re not required to participate. You may also choose to take part in only certain services you find valuable. You can change your enrollment status at any time during the calendar year. Your prescription drug coverage will not change if you take part in the MTM program.

Our purpose is to help you get the medicine you need to feel better and live well.

Download a personal medication list on our Forms & Documents page.

Learn more about Medication Therapy Management.

For additional information, contact us.

The MTM program is offered to members who qualify at no extra cost. It’s not considered a benefit.

Help Me Choose a Plan

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Now that you’ve picked a plan, it’s time to enroll.

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