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2025 Medication Therapy Management Program

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.

What is the Medication Therapy Management (MTM) program?
The MTM program is a service offered by NHC Advantage at no additional cost to you. It is required by the Centers for Medicare and Medicaid Services (CMS). It is not part of your pharmacy benefit.

How do I participate in this program?
To participate, you must meet certain criteria. These are used to identify people who have many chronic diseases and are at risk for related problems. If you meet these criteria, we will send you a letter inviting you to take part in the program. We will also send you information and provide instructions to access the program. Your enrollment in MTM is voluntary. It does not affect Medicare coverage for drugs covered under Medicare. If you do not want to be in the program, please let us know and we’ll take you out of the program. You can leave the program at any time.

To qualify for NHC Advantage MTM program, you must meet the requirements for at least one of the following two groups:

1. Have at least three of the following conditions or diseases:

  • Alzheimer’s Disease
  • Bone Disease (osteoporosis, osteoarthritis, rheumatoid arthritis)
  • Congestive Heart Failure
  • Diabetes
  • Dyslipidemia
  • End-Stage Renal Disease
  • HIV/AIDS
  • Hypertension
  • Mental Health (depression schizophrenia, bipolar disorder, other chronic/disabling mental health conditions)
  • Respiratory Disease (asthma, chronic obstructive pulmonary disease [COPD], other chronic lung disorders

AND
Take at least eight covered Medicare Part D medications.
AND
Are likely to have greater than $1,623 per year in covered Medicare Part D medication costs.
OR

2. Are enrolled in the NHC Advantage Drug Management Program as an At-Risk Beneficiary (ARB). This program helps our members safely use their prescription opioid medications, and other medications that are frequently abused

What services does the MTM program offer?
To help reduce the risk of possible problems, our MTM program offers two types of clinical review:

  • Targeted medication review: At least every three months, we will review all your prescription medications and may contact your doctor if we identify a potential problem.
  • Comprehensive medication review (CMR): At least once per year, we offer a free discussion and review of all your medications by a clinician or other health professional to help you use your medications safely. This service is provided to you confidentially on behalf of NHC Advantage via telephone by a Navitus Clinical Engagement Center clinician. The CMR may also be provided in person at your provider’s office, pharmacy, or long-term care facility

The process takes about 20-30 minutes of your time. Afterwards you will receive a written summary of the CMR, which can be helpful when you talk with your doctors. It includes:

  • Recommended To-Do-List (TDL) (also known as Medication Action Plan (MAP)): The TDL has steps you should take to help you get the best results from your medications
  • Personal Medication List (PML): The PML will help you and your health care providers keep track of your medications. It explains how to use your medications the right way

To obtain a blank copy of the Personal Medication List (PML) that can help you and your health care providers keep track of the medications you are taking, click here:

Personal Medication List

If you take many medications for more than one chronic health condition contact your drug plan to see if you’re eligible for MTM, or for more information, please contact customer service at 1-844-854-6886 (TTY 711).