Medication Therapy Management Program

Our Medication Therapy Management (MTM) Program is not a benefit but is a free service to eligible members that's designed to help members learn more about their medications and how they affect their health and well-being. We want our members to have all the information they need about their medications.  

This opportunity includes a review of your medications with our pharmacy clinical team via telephone and discusses any concerns or questions you may have. This includes over-the-counter (OTC) drugs, such as vitamins and supplements that your provider may not be aware that you're taking. This service works in partnership with your provider. You and your provider are still in control of your medications.  

To make the most of this service, we've partnered with Clarest Health. Clarest Health will have a member of their pharmacy team call you to talk with you about your medications. This is a one-time call which lasts about 15 minutes. You can have a member of your family be on the phone too, or, with your permission, your family member can be the one to speak with Clarest Health about your medications. We encourage you to complete your medication review prior to your yearly check-up. You can use the summary to discuss your drug therapy with your provider.

How can this help you?

You may be able to learn more about your medications and how they affect your health and well-being. We want our members to have all the information they need about their medications. The call may identify medications that don’t work well together or that may cause unpleasant side effects. There also may be ways to make it easier for you to take your medications, such as the time of day you take them or how often, and ways to help you remember to take your medications.

Your provider may also find this additional information helpful.

Who is eligible for the MTM Program?

Members who are:
Enrolled in a NaviCare plan AND meet the characteristics of at least one of the following groups:

Group 1:

  • Taking at least 8 maintenance Part D drugs, AND
  • Have three or more chronic conditions,* AND
  • Have reached an annual amount of $1,623 or more on Part D prescriptions 

Group 2:

  • At-risk beneficiaries (ARBs) - that is, members with an active coverage limitation under a Drug Management Program (DMP)

If you're eligible, you'll receive a letter from us explaining the program and notifying you that you have been enrolled in the program. After you receive the letter, a member of the Medication Therapy Management team will contact you by phone, unless you respond to the letter saying that you do not want to participate.

* Qualifying chronic conditions include: Alzheimer’s disease, Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis), Chronic congestive heart failure (CHF), Diabetes, Dyslipidemia, End-stage renal disease (ESRD), Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), Hypertension, Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions), Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders).

What do I receive as an MTM Program participant?

Enrolled members will receive at least one comprehensive, interactive phone consultation with a clinical team member.

The purpose of the phone consultation is to gather information to conduct a comprehensive medication review. The medication review is intended to work with the care already provided by your doctors.

The medication review may include:

  • Checking for drug-to-drug interactions, including interactions with your over-the-counter medications
  • Offering solutions that may reduce any side effects from your medications
  • Presenting ways to simplify your medication regimen
  • Helping you to remember to take your medications on time
  • Monitoring your medications and medical conditions (such as high blood pressure, high cholesterol, or diabetes) to be sure you’re getting the most out of your medications

We'll give you a written summary of the review, your complete medication list, and a list of any recommendations made by the pharmacists. We encourage you to complete your MTM review prior to your yearly check-up. You can use the summary to discuss your drug therapy with your provider.

We also perform quarterly targeted medication reviews that focus on specific actual or potential medication-related problems. These are usually fax notifications to your provider. Depending on the reason for the follow-up, you may receive a phone consultation or a mailed letter.

At least annually, you'll receive information about safe disposal of prescription drugs, drug take back programs, in-home disposal, and cost-effective means to safely dispose of such drugs.

Who can I contact for more information about MTM?

We believe that eligible members will benefit from this program and learn more about their medications. If you're contacted to participate, we hope that you'll take advantage of this opportunity.

For more details, call Enrollee Services at 1-877-700-6996 (TRS 711),
8 a.m.–8 p.m., Monday–Friday (7 days a week, October 1–March 31).

You can also call us to get copies of letters that we've sent you, to get blank medication lists or to get educational materials. You may also print a blank medication list (pdf). The blank medication list is to help you keep track of the medications you are taking.

 

NaviCare is a voluntary program in association with MassHealth/EOHHS and CMS.

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The information on this page was last updated on 10/1/2024.

Medicare Part D online forms