Medication Therapy Management Program

IU Health Plans (HMO) (HMO-POS) offers a Medication Therapy Management (MTM) program at no extra charge to you. The program is not a benefit. It is a free service offered to those who are eligible and qualify for the program. Once enrolled in the program, there are no changes to your copays or other benefits.

The MTM Program helps you get the most benefit from your medications by:

• Making sure you are taking the right amount of medication at the right times
• Making sure your medications are not interacting with each other or causing side effects
• Making sure you are taking only medications you need and not taking medications you don’t need
• Looking for ways you can save money on your medications

Who qualifies for the MTM Program?

To qualify for the MTM program, you must meet all of the following criteria:

• You have at least 3 of these conditions: Alzheimer’s disease, Arthritis, Congestive Heart Failure (CHF), Diabetes, High Cholesterol, End-Stage Renal Disease (ESRD), HIV/AIDS, High Blood Pressure, some Mental Health conditions, and Respiratory Disease like Asthma or Chronic Obstructive Pulmonary Disease (COPD)
  
• You take at least 8 covered Part D drugs to manage your chronic conditions
• Your prescription medications are likely to cost at least $1,623 in 2025

You may also qualify for a review with a pharmacist if you are using controlled substance medications and/or you are an At-Risk Beneficiary (ARB) under the plan’s Drug Monitoring Program (DMP).

If you qualify, you’ll receive a welcome letter mailed to your home. Medicare requires MTM programs to automatically enroll members who qualify throughout the calendar year but participation is voluntary, and you can choose not to participate at any time. The welcome letter provides instructions on how to opt out of the program.

Comprehensive Medication Review (CMR)

Those enrolled in the MTM program will be offered a comprehensive medication review (CMR).  A CMR is a one-on-one consultation between you and one of our clinical pharmacists.  The pharmacist will review all of your medications and medical conditions and answer any questions you may have. The review will take place over the phone.

The pharmacist will offer ways to manage your conditions with the drugs you take. If any issues are identified, the pharmacist may work with your doctor to help get them resolved.  A CMR takes about 30 minutes and is usually offered once each year to qualifying members.

At the end of your consultation, you will receive a cover letter, a Recommended To-Do List, and a Personal Medication List within two weeks of speaking with the pharmacist. The Recommended To-Do List has steps you should take to help you get the best results from your medications. The Personal Medication List will help you keep track of your medications and describe how to use them the right way.

Click here for the Personal Medication List.

Targeted Medication Review (TMR)

You may also have Targeted Medication Reviews (TMRs) performed for you. TMRs are identified on at least a quarterly basis (every three months) to address potential medication-related issues. When these issues are identified, the doctor prescribing the medication may be contacted about the potential issue and provided suggested interventions. As always, your prescribing doctor will decide whether or not to consider our suggestions. You may also receive information about a TMR directly, when needed.

Information Regarding Safe Disposal of Controlled Substance Medications

Part of keeping you healthy and safe is to provide you information on how to dispose of controlled substance medications when they are no longer needed. As part of the MTM program, this information will be mailed to your home. You can also access this information below.

Click here for information regarding the safe disposal of controlled substance medications. 

How can I get more information about the Medication Therapy Management Program? 

• If you would like information about the MTM program, please contact our Member Services department at 800.455.9776. 
• MTM Pharmacy Services can be reached at 866.823.1633 9am – 5pm EST, Monday through Friday. TTY users dial 711.