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Medication Therapy Management Program (MTMP)

If you take multiple medications, it is important to understand how to take them properly and if there’s any risk of adverse drug interactions. The MTMP can help you do that.

The Centers for Medicare & Medicaid Services (CMS) requires all Part D sponsors—like the Health Options Program—to offer the MTMP to eligible members. The Program is designed to help members better understand their medications, ensure appropriate use and reduce the risk of adverse events. Health Options Program members who meet the criteria below are eligible for the MTMP at no additional cost as part of their Medicare coverage.

  • Filled eight or more chronic Part D medications; and
  • Have at least three of the following ten chronic conditions:
    • High Blood Pressure
    • High Cholesterol
    • Congestive Heart Failure (CHF)
    • Diabetes
    • Depression
    • Osteoporosis
    • Rheumatoid Arthritis
    • Asthma
    • COPD
    • HIV
  • Be likely to incur annual costs of $4,376 for all covered chronic Part D medications.
  • Please note the followingTake the Call: It's the Medication Therapy Management Program! If you or any of your dependents are eligible for the MTMP, you may receive a call from OptumRx. OptumRx representatives will call from 855-773-8254 or 866-352-5305.

How it Works

OptumRx, the administrator for the Medicare Prescription Drug Options, will contact eligible members to invite them to participate in the MTMP. If you qualify for the program and do not opt out, you will be automatically enrolled in the program. The brochure sent in the mail explains how you can opt-out of the MTMP. The services available help to better manage multiple conditions by:

  • Ensuring medications are taken correctly
  • Improving medication adherence
  • Detecting potentially harmful medication uses or combinations of medications
  • Educating members and health care providers

Overview of Comprehensive Medication Review (CMR)

The CMR includes three components:

  1. Review of medications to assess medication use and identify medication-related problems. This may be conducted person-to-person or "behind the scenes" by a qualified provider and/or using computerized, clinical algorithms.
  2. An interactive, person-to-person consultation performed by a qualified provider at least annually to all MTM-eligible members.
  3. An individualized, written summary of the consultation for the member, including but not limited to, a personal medication list (PML), reconciled medication list, action plan, and recommendations for monitoring, education, or self-management.

NOTE: If OptumRx is unable to reach you by mail, you will recieve a call from an OptumRx representative at 1-855-773-8254 or 1-866-352-5305 notifying you of your eligibility. If you do not answer the call, a representative will leave a voicemail message with a 7-digit pin. You will need this pin if you call back from a different number than the one OptumRx has on file for you. You will also be asked to verify your date of birth and zip code.

Who is OptumRx?

OptumRx is the Health Options Program’s Pharmacy Benefit Manager. They manage the Medicare Prescription Drug Options, pharmacy networks, coordinate with drug companies and manage the Medication Therapy Management Program. Any information OptumRx collects about your health and medications is confidential and will be used for the purposes of the Medication Therapy Management Program only, which may include reaching out to your doctor.

For more information

Use the links below to get more information on the Medication Therapy Management Program.

Last modified: October 6, 2020