What is the MTM (medication therapy management program)?

Medication Therapy Management (MTM), while not part of a prescription drug benefit, is a Medicare-designed program offered by Humana.

By participating in the program we want to help you get the best results from all of the medications you’re taking. When you talk to a trained provider they can help you make sure your medications are working for you, may help you find lower cost options, and answer any questions or concerns you may have about your medications.

If you're like many of Humana's Medicare members, you're taking multiple medicines prescribed by more than one doctor. You could also be taking medicines that, when combined, may:

• Reduce the effectiveness of your medicines
• Cause severe side effects
• Cost you more money per month

As part of your Medicare Part D coverage with Humana, you can set up a one-on-one review of your medicines with a pharmacist or other trained health care provider. This review is called a comprehensive medication review (CMR) and is offered at no extra cost to you. Once enrolled in the program, you or your prescriber may be contacted about a targeted medication review (TMR) if an issue is identified with your medications that require you or your prescriber's attention. If the MTM provider finds an issue during a CMR or a TMR that requires your prescriber’s attention they may receive a telephone call or a fax from the MTM provider.

Humana determines eligibility quarterly by looking at your medication claims information. Once you qualify, you remain in the program for the rest of the calendar year. You will have to re-qualify for the next calendar year.* Humana’s criteria:

2023 Criteria

You meet all 3 of the following:

• You have 3 of the 5 following chronic diseases:
  • Osteoarthritis, Hypertension, Asthma, Chronic heart failure, Schizophrenia AND
• You are taking 8 or more chronic/maintenance (Part D) drugs, AND
• You’re likely to have annual Part D medication costs of $4,935 or more in 2023

OR

You qualified for the Drug Management Program because:

• You’re taking an opioid medication prescribed by more than 1 healthcare provider and/or using more than 1 pharmacy, OR
• You’ve had a drug-related hospital visit in the last 12 months and have been prescribed an opioid in the last 6 months

Once eligible, you will be auto-enrolled and will receive notification within 60 days inviting you to participate in the program.²

Once enrolled,^† you can visit any participating pharmacy for an in-person consultation or call Humana directly to be put in touch with a MTM Provider who can perform your consultation over the phone.

You may also call us at 888-686-4486 (TTY: 711). Representatives are available Monday through Friday, 9 a.m. to 7 p.m. EST.

Humana also works with other health organizations to provide MTM services on our behalf and one of these organizations may contact you about completing a Comprehensive Medication Review or other MTM services.

Partner organizations: Aspen RxHealth, Outcomes and MedWatchers

A trained pharmacist or health care provider will review your current medication program to:

• Go over the medicines you are currently taking
• Make sure your medicines are safe for you
• Answer any questions you may have about your medicines
• Discuss possible lower-cost alternatives for your medicines
• Discuss any concerns you have about your medicines
• Work with you on ways to keep track of your medicines
• Send you a summary of your consultation that includes the Personal Medication List, which is a list of all of the medications you're taking, and a To-Do list, which includes things that you talked about with the MTM provider

Each consultation takes about 15 minutes to complete but can range from about 10-30 minutes.

For your convenience, you can print a blank medication list by using the attachment below. Please use the form to keep track of all your prescriptions and over-the-counter medications.

Printable Personal Medication List – English , PDF opens new window

Printable Personal Medication List – Spanish , PDF opens new window