Medication Therapy Management

EmblemHealth Medication Therapy Management (MTM) Program

The MTM Program is a free service for EmblemHealth Medicare plan members with a Part D prescription drug coverage who have certain health conditions and who take a certain number of prescription medications covered by Medicare Part D. The MTM Program helps you and your doctor make sure that your medicines are working to improve your health.

A pharmacist or a health care provider will review your prescription medicines, over-the-counter drugs, and any herbal supplements you may take to make sure they are safe and working for you. Our health care professionals will help you understand your medications and how to take them and answer any questions and concerns you may have.

To participate in the MTM program, you must be eligible. If you qualify, we will automatically enroll you – at no additional cost to you. The MTM Program is a voluntary program.

To find out more about the MTM Program or to see if you qualify, you can call EmblemHealth Pharmacy Services at 888-447-0321, Monday to Friday, 9 am to 5 pm. If you use a TTY, please call 711, Monday to Friday, 9 am to 5 pm.

Although the MTM program is a special program provided to Medicare members, it is not considered a benefit.    

EmblemHealth Medicare HMO plans

To be eligible for MTM, you take seven or more prescription medications covered by Medicare Part D and you have at least three of the eight following conditions:

  • Asthma
  • COPD
  • Diabetes
  • Chronic Heart Failure
  • High Cholesterol
  • Rheumatoid Arthritis
  • Osteoporosis
  • HIV

You are likely to spend $4,255 or more in 2020 on prescription medications covered by Medicare Part D.

EmblemHealth Medicare HMO plans

To be eligible for MTM, you take seven or more prescription medications covered by Medicare Part D and you have at least three of the eight following conditions:

  • Asthma
  • COPD
  • Diabetes
  • Chronic Heart Failure
  • High Cholesterol
  • Rheumatoid Arthritis
  • Osteoporosis
  • HIV

EmblemHealth Affinity Medicare plans

You take eight or more prescription medications covered by Medicare Part D and you have at least three of the eight following conditions:

  • Asthma
  • COPD
  • Diabetes
  • Chronic Heart Failure
  • Depression
  • Osteoporosis
  • HIV
  • Cardiovascular Disorders such as High Blood Pressure, High Cholesterol, or Coronary Artery Disease

You are likely to spend $4044 or more in 2019 on prescription medications covered by Medicare Part D.

If you are eligible you will:

  • Get a welcome letter that tells you how to get started.

  • Be contacted to have a phone appointment to receive a full medication review with an EmblemHealth pharmacist or health care provider. The review can take up to 30 minutes or longer depending on your medication profile. During this call, the pharmacist or health care professional will review your prescription, over-the-counter medicines and any herbal supplements you may take to make sure they are safe and working for you. We want to be sure you understand your medicines and how to take them and will answer any questions and concerns you may have.

  • Receive a personal medication list, which will be mailed to you after the call. Your personal medication list includes all of the medicines you take for your chronic conditions and explains how and why you take them. You will also receive a medication action plan to remind you about what you talked about during the call and what you need to do.

  • Have your medicines reviewed for any medication-related issue(s) every quarter. If there are any issues, your doctor will get a letter explaining the issue(s).

MY COVERAGE

Drugs Covered

At EmblemHealth, we offer Medicare plans that cover a wide range of prescription drugs. For your convenience, there is a complete list of all covered drugs in our comprehensive formularies.

YOUR MEDICATION

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Find out how to set up home delivery or a get a prescription refill.

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Last Updated 10/1/19

Y0026_ 127364 Accepted 10/1/19

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