If you have a CHPW Medicare Advantage (HMO D-SNP) plan or a Medicare Part D drug plan, and complex health needs, you may be eligible to receive routine medication reviews by a pharmacist or other health professional at no additional cost with the Medication Therapy Management (MTM) Program.*
What is Medication Therapy Management (MTM) program?
This program offers routine medication reviews from a pharmacist or other health professional to help you and your doctor make sure that your prescription medications are working. These reviews are quick and can help you:
- Get the best results from your medicines, including tools to stay on track.
- Find possible problems, like side effects or medicines that may not work well together.
- Get answers to questions from a pharmacist or a qualified health care professional.
- Make sure your medicines support your overall health care needs.
- Use your medicines safely and correctly.
Who is eligible?
If you are a CHPW Medicare Advantage member who may benefit from support to manage your prescription medications, you may qualify if you:
- Take certain prescription medications, such as specific pain medicines, or meet other criteria defined by the Centers for Medicare & Medicaid Services* (42 CFR §423.153 (d))
– Or –
- Meet ALL of the following criteria:
-
- Have at least three of the following conditions:
- Alzheimer’s Disease
- Bone disease-arthritis (Including osteoporosis, osteoarthritis, and rheumatoid arthritis)
- Chronic congestive heart failure (CHF)
- Diabetes
- Dyslipidemia
- End-stage renal disease (ESRD)
- Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
- Hypertension
- Mental health (Including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
- Respiratory Disease (Including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
- Take at least eight covered Part D maintenance medications, AND
- Are likely to have medication costs of covered Part D medications greater than $1276 (2026) or $1340 (2027) per year.
- Have at least three of the following conditions:
How does it work?
If you are eligible, you will receive a letter from CHPW with one of our pharmacy partners inviting you to participate in the program. The letter will include information about the program and what to do to get started.
Medication Therapy Management Services are provided by our pharmacy benefit manager, Express Scripts, and other partners who specialize in pharmacist-led medication reviews:
- Outcomes®
- MedWatchers
- Arine, Inc and PipelineRx
You can choose not to participate, and it will not affect your coverage.
There are two types of medication reviews included in the program:
1. Targeted Medication Review (Quarterly review)
- Your time commitment: 0-30 minutes
- How often: Every 3 months
You don’t need to do anything for a Targeted Medication Review (TMR). Your prescription medications will be reviewed independently based on information your pharmacy sends to our review team.
If there are concerns about the dose or safety of a medication, our review team will contact your pharmacist or doctor, and in some cases, you.
2. Comprehensive Medication Review (Yearly appointment to review)
- Your time commitment: 15-30 minutes.
- How often: At least once per year
To complete the Comprehensive Medication Review, a pharmacist or representative will contact you to schedule an appointment to review all your medications.
During the appointment, together with the pharmacist or health professional, you will review your prescription medications, vitamins, herbal products, supplements, and other over-the-counter medications. During this time, you can also ask questions.
While reviewing your medications, the pharmacist looks for:
- Potential conflicts (two drugs not working well together)
- Duplication (two drugs that do the same thing)
- Side effects (symptoms from a drug)
- Ways to help lower your prescription drug costs
After the review, the pharmacist will work with you, and your doctor if necessary, to resolve any medication-related concerns.
You will also get a written summary of your consultation by mail, including:
- Medication Action Plan, also called your Recommended To-Do List: Steps to take to help you get the best results from your medications.
- Personal Medication List (PML): Use this tool to keep track of which medications you are using, what they treat, and who prescribed them.
For more information or to find out if you are eligible, contact our Customer Service Team at 1-800-942-0247 (TTY:711) 8 a.m. to 8 p.m., seven days a week.
Resources
Download a blank copy of the Personal Medication List (PML):
The Personal Medication List (English) | La Lista de Medicamentos Personales (Espanol)
Get more details in CHPW’s policy: Medication Therapy Management Program Policy
*The Medication Therapy Management (MTM) program is required by the Centers for Medicare & Medicaid Services for Medicare Part D plans. It is not considered a Part D benefit. Eligible members receive these services at no additional cost.
