Medication Therapy Management (MTM)

Back To Prior Authorizations

If you are enrolled in Banner Medicare Rx PDP and have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Banner Rx at no additional cost to you.

The MTM program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.

To take part in this program, you must meet certain criteria set forth in part by Medicare. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

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

  • Have at least 3 of the following conditions or diseases: Bone Disease-Arthritis-Osteoporosis, Chronic Heart Failure (CHF), Diabetes, Dyslipidemia, End-Stage Renal Disease (ESRD), Hypertension, Mental Health-Depression, Asthma, Chronic Obstructive Pulmonary Disease (COPD), AND
  • Take at least 8 covered Part D medications that are chronic/maintenance medications, AND
  • Are likely to have medication costs of covered Part D medications greater than $4,935 per year.

OR

You qualified for the Drug Management Program (DMP) because:

  • Review of your level of opioid use from multiple prescribers/pharmacies.
  • A medical history of an opioid-related overdose within the most recent 12 months and a recent opioid prescription within the most recent 6 months.

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor if we detect a potential problem.

Comprehensive medication review: at least once a year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. This review, or CMR, is provided to you confidentially via telephone by MedWiseRx or Outcomes MTM, which provides this service on behalf of Banner Rx. This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors. This summary includes:

Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications.

Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

If you take many medications for more than one chronic health condition, call our Customer Care Center to see if you’re eligible for our MTM program.