Medication Therapy Management Program
You can get help finding any possible errors or gaps in your prescription drug care with our Medication Therapy Management Program.
What is the Medication Therapy Management Program?
The Medication Therapy Management Program is a part of HealthSpring Medicare Part D Prescription Drug Plans and HealthSpring Medicare Advantage Plans (Part C) with prescription drug coverage.
MTM can help you find any possible gaps in your care by:
- Lowering the risk of medication errors, especially if you have chronic conditions, take many medications or see multiple doctors
- Giving you information on proven medical practices to help you and your doctor decide the most effective treatment
- Helping you understand your condition and medications, so you may improve your well-being
Medication Therapy Management Program FAQs
How do I qualify for the MTM Program?
There are two ways to qualify for program assistance and become enrolled in the MTM program.
The first way to qualify for program assistance is if you meet all three of the following criteria:
1. Medical Conditions: You have at least three of the following medical conditions:
- Alzheimer's Disease
- Bone-disease Arthritis (including osteoporosis, osteoarthritis and rheumatoid arthritis)
- Chronic congestive heart failure
- Diabetes
- Dyslipidemia
- End-stage renal disease (ESRD)
- Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
- Hypertension
- Mental health condition (including depression, schizophrenia, bipolar disorder and other chronic disabling mental health conditions)
- Respiratory disease (including asthma, chronic obstructive pulmonary disease and other chronic lung disorders)
2. Medications: You take at least eight maintenance Part D prescription drugs.
3. Drug Spend Threshold: Your prescriptions for the last three months cost more than one-fourth of the yearly cost level. The Centers for Medicare & Medicaid Services set a cost level each year. The 2025 cost level is $1,623. The 2026 cost level is $1,276.
The second way to qualify for program assistance is if you are identified as an At-Risk Beneficiary under the plan’s Drug Management Program for potential misuse of opioid medications.
How do I get started with the MTM program?
HealthSpring members who qualify for the MTM Program are automatically enrolled1. A welcome packet is sent to them in the mail.
Based on the guidelines above, all chosen members will be offered a Comprehensive Medication Review by a clinical pharmacist at least yearly. The average call time for the medication review is 20 minutes. But our pharmacists will take as much time as needed to answer all your questions. The CMR is an interactive session with one of our clinical pharmacists to talk about all your medications, including:
- Prescriptions
- Over-the-counter medications
- Herbal therapies
- Dietary supplements
You’ll receive a letter in the mail after your medication review. Your letter will have a personal list of all medications discussed and a plan of action, if needed. Your health care provider(s) who prescribed your medications may also get a letter after your CMR. Their letter will include possible interventions to solve medication-related problems or other ways to improve medication use.
Also, if you are eligible, we will automatically complete a Targeted Medication Review each quarter. After the TMR, we will mail your prescriber(s) a letter with intervention opportunities.
Getting involved in the MTM Program may help improve your health and lower your risk for medication reactions, hospitalization and emergency room visits. Depending on your diagnosis, it may help improve your cholesterol and blood sugar levels and lower your risk of heart attack.
How much will the MTM program cost me?
There is no extra cost for this program. While the MTM program is not a Medicare benefit, it is part of the plan you select for coverage.
How can I safely dispose of my medications?
You will receive information on how to safely dispose of your medications in your MTM Program welcome packet. It’s important to get rid of unwanted medication in a way that won’t put others in danger. You can drop off unwanted medications at certain authorized pharmacies and collection sites on National Prescription Drug Take Back Day. Or go to an approved location near you anytime throughout the year.
Still have questions?
Or want more information about the MTM Program? Please call us at the number for your plan:
Medicare Advantage Plans (Part C)
Medicare Part D Prescription Drug Plans
Comprehensive Medication Review appointments are available 8 a.m. – 6 p.m. ET, Monday – Friday.
You do not need an appointment to ask questions about the MTM program.
For questions about Medicare plan benefits, coverage issues or claims, please contact us.
1 Unless you opt-out of enrolling in the program.
The Medication Therapy Management (MTM) Program is a component of HealthSpring prescription drug plans and should not be considered a Medicare benefit. MTM is neither offered nor guaranteed under our contract with the Medicare program and is not subject to the Medicare appeals process.