What is the Medication Therapy Management Program?

The Medication Therapy Management Program (MTM) is aimed at improving your health and quality of life by ensuring safe and effective medication use and preventing medication-related issues. If you have multiple health conditions, MTM can help you organize your medications, better understand your health conditions, and address any health-related concerns.

The Triple-S Advantage (TSA) MTM Program is managed by a diverse group of healthcare professionals, composed of case managers, pharmacists and registered nurses. They will work in collaboration with you to obtain the maximum benefit from your medications, guaranteeing they are safe, appropriate and are working properly. Additionally, your prescriber will be contacted, if necessary, to resolve any medication related problem.

This Program is not part of your plan benefits package.

Who is eligible to participate in the MTM Program?

To participate beneficiaries must comply with the eligibility requirement of at least one of the following two groups, according to the criteria established by the Centers for Medicare and Medicaid Services (CMS):

1) Beneficiaries who satisfy the following three (3) criteria:

  • Have three (3) or more chronic diseases:

    1. Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
    2. Congestive heart failure (CHF)
    3. Diabetes
    4. Dyslipidemia
    5. Respiratory disease (including chronic obstructive pulmonary disease (COPD) and asthma)
    6. Hypertension
    7. Alzheimer’s Disease
    8. End-stage renal disease (ESRD)
    9. Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
    10. Mental health (including depression, schizophrenia, and bipolar disorder)
  • Use eight (8) or more Medicare Part D drugs related to the chronic conditions named above;
  • Utilize more than $1,340 in total Part D drug costs per year.

2) Are at-risk beneficiaries with an active coverage limitation under a drug management program (DMP).

How much does the Program cost?

The MTM Program is offered at no additional cost to those beneficiaries who are eligible.

What services does the MTM Program provide?

Here’s what you’ll get when you join:

  • A full comprehensive review of your medications (CMR): This review will include medications prescribed by your doctor and over-the-counter medications like vitamins and herbal supplements. It will be conducted by phone or in person at least once a year and will take about 30 minutes of your time. You will receive a written summary by mail within 14 days of your CMR.
  • Help with your medications: We’ll teach you how to take your medications the right way and answer any questions you may have.
  • A medication list: We’ll create a personalized list that shows how to take each medication and will help you stay on track. You may print this list, fill in the information and bring it to your doctor or hospital visits, or share it with anyone helping care for you (view example).
  • An action plan: We’ll give you a simple To-Do List that includes the steps you should take to get the best results from your medication therapy.
  • Ongoing support: We’ll check in with you through the Targeted Medication Reviews (TMRs) that are sent by mail on a quarterly basis immediately upon enrollment in the MTM program with follow-up interventions when necessary. If potential or specific medication-related problems are identified, follow-up calls may be scheduled more often as needed to address these.
  • Safety checks: We’ll evaluate the risk of potential drug interactions.
  • Checking for side effects: We’ll ensure you are not experiencing any side effects from your medications.
  • Contact your doctor: We’ll reach out to your doctor if a medication-related problem is identified.
  • Safe disposal of medications: We’ll help you to learn how to safely dispose of your prescription drugs, including opioids and other controlled medicines. We’ll guide you through take-back programs and at-home disposal options. Plus, we’ll help you locate two or more take-back sites in your community.

How can I participate in the MTM Program?

Once the eligible beneficiaries are identified, they are considered automatically enrolled in the program and will receive a Welcome Letter with detailed information by mail within 60 days to invite you to participate in the MTM program. This program is voluntary and you can request an opt-out at any moment.

If you have questions regarding our MTM Program or would like to receive additional information, please contact us at 1-855-831-3592, Monday through Friday from 8:00am to 5:00p.m. TTY users please call 1-855-296-8965.

Triple-S Advantage is an independent licensee of BlueCross BlueShield Association.