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Medication Therapy Management

The Medication Therapy Management (MTM) program is offered to members who are enrolled in our Medicare Part D prescription drug plans. MTM is a free, voluntary program, with limited eligibility requirements, to assist with managing a long-term health condition. MTM is an educational program and is not a Medicare Part D plan benefit.

Who can participate in the MTM program?

Members who meet three of the following criteria are eligible:

  • Members who have at least three of the following chronic diseases:
    • Alzheimer’s
    • Bone Disease - Arthritis
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia
    • End-Stage Renal Disease (ESRD)
    • HIV/AIDS
    • Hypertension
    • Mental Health
    • Respiratory Disease
  • Members who are taking at least eight or more Part D covered drugs.
  • Members who are likely to incur costs for covered Part D drugs of at least $1,340.00 or more annually.

If you do not meet the above requirements for the MTM program, Capital Blue Cross may still determine you to be an at-risk beneficiary who could benefit from this service.

What does the MTM Program do?

The MTM Program is designed to:

  • Provide helpful information about the medications you take to manage your chronic diseases
  • Reduce your risk of drug reactions and harmful side effects
  • Help you use your medications as effectively as possible

How will I know if I'm selected?

If you qualify for the MTM program, you will receive a letter from Prime Therapeutics, Capital Blue Cross's MTM program partner. To schedule your one-on-one medication review, you may call the number provided in the letter, or an MTM pharmacist may contact you directly.

The pharmacist offers ways to manage your conditions with the drugs you take. The pharmacist may contact your prescribing doctor. A Comprehensive Medication Review (CMR) takes about 30 minutes and is usually offered once each year if you qualify. At the end of your discussion, the pharmacist will give you a Patient Medication List of the medications you discussed during your CMR review as well as a Recommended To-Do List.

We will mail or fax a Targeted Medication Review (TMR) to your doctor every three months. The TMR includes suggestions regarding prescription drugs that may be safer or more efficient than the drugs you currently take. Your prescription drugs will not change unless you and your doctor decide to make a change.

How can I get more information about the MTM Program?

If you have additional questions, please call 866.686.2223 (TTY: 711), Monday-Friday 9AM-6PM.

Safe Disposal of Prescription Drugs

Information regarding the safe disposal of prescription and OTC drugs will be included in your welcome letter and are available at the DEA Diversion Control Division public search website.

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Updated October 1, 2026

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