The Medication Therapy Management (MTM) Program

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Can the Medication Therapy Management (MTM) program help you with your medications?

If you receive your Medicare Part D drug coverage through Tufts Health Plan, you may be eligible for a Medication Therapy Management (MTM) program.

What is the MTM program?

Medication Therapy Management is a clinical program that provides education and information about your medicines. As part of this program, Tufts Health Plan members are provided with a pharmacist’s review of their medicines to look for ways to improve their drug therapy. Services offered through the MTM program include a Comprehensive Medication Review and Targeted Medication Reviews.

Who is it for?

Enrollment in this program is automatic if you meet specific criteria based upon:

  • The number of certain chronic conditions you may have
  • The number of covered Part D medications you may take
  • The estimated annual cost for your covered Part D medications

MTM Program Criteria
 

2025 MTM Program Criteria
Members must meet the following three criteria, or be enrolled in the plan’s Drug Management
Program, to be eligible for MTM services:

  1. You have at least three (3) of the following chronic conditions:
    • Alzheimer’s Disease
    • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
    • Chronic congestive heart failure (CHF)
    • Diabetes
    • End Stage Renal Disease (ESRD)
    • High Blood Pressure (Hypertension)
    • High Cholesterol (Dyslipidemia)
    • HIV/AIDS
    • Mental Health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health disorders)
    • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
  2. Taking at least 8 Part D covered maintenance medications
  3. Have at least $1,623 in estimated annual costs on Part D covered medications

 

2024 MTM Program Criteria
Members must meet the following three criteria, or be enrolled in the plan’s Drug Management
Program, to be eligible for MTM services:

  1. You have at least three (3) of the following chronic conditions:
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Chronic Heart Failure (CHF)
    • Diabetes
    • High Blood Pressure (Hypertension)
    • High Cholesterol (Dyslipidemia)
  2. Taking at least 8 Part D covered medications
  3. Have at least $5,330 in estimated annual costs on Part D covered medications

 

What are the benefits of MTM?

  • Pharmacists lower the risk of drug related problems, including medication errors and side effects
  • Pharmacists offer helpful tips on how to take your medicines
  • Pharmacists identify ways to reduce the cost of your medicines by eliminating duplicative therapy and suggesting lower cost formulary alternatives, if available

What is a Comprehensive Medication Review?

A Comprehensive Medication Review is a one-on-one telephone or face-to-face consultation with a pharmacist during which the member’s entire medication profile is reviewed for appropriateness of therapy. The review includes all prescription medications, over-the-counter medications, herbal supplements, and sample medications, and should take no more than 20 minutes. Best of all, the CMR gives the member an opportunity to ask the pharmacist any questions he or she may have about the medications he or she is currently taking. Following the CMR, the pharmacist sends the member a Recommended To-Do List and a Medication List.

What is a Targeted Medication Review (TMR)?

During a Targeted Medication Review, a pharmacist looks for opportunities to improve a member’s medication regimen. Following a TMR, pharmacists may reach out to members and/or their providers via phone, mail, or fax in order to discuss their findings. Targeted Medication Reviews are conducted on a quarterly basis for members who have not opted-out of the program.

How do I participate in the MTM program?

If you are eligible for the MTM program, you will receive an Enrollment Letter from our MTM partners at OptumRx. You may also receive a phone call. The letter will provide information about how to schedule your Comprehensive Medication Review with a pharmacist, which may be done by returning the enclosed form or by calling the provided toll-free number. OptumRx may also contact you by phone from their Medication Management Center to offer you a CMR.

For members not interested in participating in the MTM program, information regarding how to opt-out is also provided in the Enrollment Letter.
Participation in the MTM program is voluntary and available at no cost to Tufts Health Plan members. Participating in this program is not considered a covered benefit.

How do I safely dispose of my unused and/or expired medications?

It is important to properly dispose of unused and/or expired medications as soon as possible before they can do harm.  The following are ways to safely get rid of medications you no longer need:

  • Find a nearby pharmacy or other local resource with a medication take back service.* The US Drug Enforcement Administration (DEA) sponsors two formal drug Take Back Days a year: in April and October.  They also endorse year-round collection at select pharmacies and other authorized sites.  You can find a site near you, and information on the drug Take Back Days, on the DEA’s website: www.deatakeback.com. *This is the preferred method for disposing of unused controlled substances, such as opioid medications.
  • Dispose of the medication in your household trash. If you are unable to bring your unused medication to a DEA-endorsed take back site, there is a way to safely dispose your medication at home:
    • Remove the medication from its original container and mix it with an undesirable substance such as kitty litter, dirt, or used coffee grounds.
    • Put the mixture into a sealable bag or disposable container with a lid, such as an empty margarine tub, then place the sealed container in your trash.
    • To protect your privacy, when disposing your original prescription containers, make sure to conceal or remove any personal information, including Rx number.  You can do this by covering it with black permanent marker or duct tape, or by scratching it off.
  • Can I flush my medication down the toilet? Trace amounts of medications that are flushed down the toilet may end up in our water supply.  It is important to only flush unused or expired medications down the toilet if the prescription drug labeling or patient information that came with the medication said to, or no other disposal options are available.

More information on the safe disposal of medications can be found on the United States Department of Health and Human Services (HHS) website: https://www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html

Tufts Health Plan Medicare Advantage Members: 

Print a blank copy of the Personal Medication List (PML)(PDF) to keep for your records and share with your provider.  You may also contact our Member Services department to request a copy.

 

Other Helpful Information

HMO Premium Changes Low Income Subsidy

For More Information

For questions regarding the Tufts Health Plan’s Medication Therapy Management program in partnership with OptumRx, please contact our Member Services team at 1-800-701-9000 (HMO) or 1-866-623-0172 (PPO) (TTY: 711).