Medication Therapy Management Program

How the MTM Program Works

Safely Dispose of Unused or Expired Medications

For More Information

If you take multiple medications, it is important to understand how to take them properly and whether there’s any risk of adverse drug interactions. The MTM program 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 MTM program 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 MTM program 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 10 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 $5,330 in 2024 for all covered chronic Part D medications.

OR

• Are in a Drug Management Program to help better manage and safely use medications such as opioids and benzodiazepines

Take the call: It’s the Medication Therapy Management program! 

If you or any of your dependents are eligible for the MTM program, you may receive a call from Optum Rx. Optum Rx representatives will call from 1-855-773-8254 or 1-866-352-5305.

How the MTMP Works

Optum Rx, the administrator for the Medicare Prescription Drug Options, will contact eligible members to invite them to participate in the MTM program. 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 MTM program. 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

Our programs are evidence-based and can integrate both pharmacy and medical data, when available, and are built upon multiple measures that demonstrate positive clinical outcomes for members like you. Pharmacists, physicians, and Ph.D.s develop, manage, and evaluate the programs for effectiveness.

One-on-one consultations between our clinicians and members are also an important part of our MTM program. Such consultations ensure that members are taking their medications as prescribed by their health care provider.

Overview of comprehensive medication review (CMR)

The Centers for Medicare & Medicaid Services (CMS) requires all Part D sponsors to offer an interactive, person-to-person comprehensive medication review (CMR) to all MTM-eligible members as part of the MTM program. If you meet the criteria outlined above, you will receive an MTM program enrollment mailer or phone call offering our CMR services. A CMR is a review of a member’s medications (including prescription, over-the-counter (OTC), herbal therapies, and dietary supplements) that is intended to aid in assessing medication therapy, as well as optimizing outcomes. Also, MTM-eligible members will be included in quarterly targeted medication review (TMR) programs that assess medication profiles for duplicate therapy or drug-disease interaction in which members’ prescribers may receive a member-specific report.  

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 Optum Rx is unable to reach you by mail, you will receive a call from an Optum Rx 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 seven-digit PIN. You will need this PIN if you call back from a different number than the one Optum Rx has on file for you. You will also be asked to verify your date of birth and ZIP code.

What is Optum Rx?

Optum Rx is the Health Options Program’s Pharmacy Benefit Manager. They manage the Medicare Prescription Drug Options, pharmacy networks, and the Medication Therapy Management program, and coordinate with drug companies. Any information Optum Rx 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.

Safely Dispose of Unused or Expired Medications

Are you looking for a safe way to dispose of unused, expired medications? Don’t just throw them away. Here are a few tips for safe disposal:

• Find a nearby pharmacy or other local resource with a medication take-back service.
  • The U.S. Drug Enforcement Administration (DEA) allows unused prescription medications to be returned to pharmacies or other authorized sites. You can locate participating locations.
  • Community take-back sites are the preferred method of disposing of unused controlled substances.
  • Additional drug disposal information can be found on the DEA website at: deatakeback.com. 
• If you cannot get to a drug take-back location promptly, or there is none near you:
  • Mix the unused supply with an undesirable substance such as dirt or coffee grounds.
  • Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag, then place the sealed container in your trash.
  • Make sure to conceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off to protect your privacy.
  • Place both the sealed container with the mixture and the empty drug containers in the trash.
  • Flush approved unused or expired medications down the toilet only if indicated on the label or if 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 website.

For More Information

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

• MTM Program Enrollment Mailer (sample copy) (PDF 415KB)
• MTM Program Recommended To-Do List (Form CMS-10396) (Expires 02/24) (PDF 125KB)
• MTM Program Standardized Format Medication List (Form CMS-10396) (Expires 02/24) (PDF 147KB)
• To learn more, visit Optum Rx’s website. 

If you have any questions about the MTM program, please call the MTM Department at 1-866-352-5305 (TTY users dial 711), Monday through Friday, 8:00 a.m. to 8:00 p.m. CT.

Last Modified: January 22, 2024