Medication Therapy Management

Pharmacist helping senior customer with prescription medicine

Medication Therapy Management (MTM) Program

The Medication Therapy Management (MTM) Program is a free service for EmblemHealth Medicare plan members with Part D prescription drug coverage who have certain health conditions and take certain prescription medications covered by Medicare Part D.

The MTM Program helps you and your doctor make sure that your medications are working to improve your health. It can also help prevent any issues with your medications.

Watch our short video to learn more about the program.

Eligibility

Find out if you are eligible for the program.

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About the MTM Program

Participation is voluntary and there is no added cost to you.

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How Does the MTM Program Work?

Learn more about the program and how to get your personal medication list and medication action plan.

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Speak to a Pharmacist

Members can schedule an appointment with one of our pharmacists to learn more about the MTM Program.

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2025 Eligibility
2024 Eligibility

For EmblemHealth VIP Medicare Advantage Prescription Drug Plans:

To be eligible, you must meet the criteria of at least one of the following two groups (1) and/or (2).

1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D
2. You have at least three of the following conditions:
  - Chronic congestive heart failure (CHF)
  - Diabetes
  - Hypertension (high blood pressure)
  - Dyslipidemia (high cholesterol)
  - Alzheimer’s Disease
  - Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
  - End-stage renal disease (ESRD)
  - Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
  - 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)
3. You must be likely to spend $1,623 or more in 2025 on prescription medications covered by Medicare Part D
You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid (CMS) guidelines.

For EmblemHealth Prescription Drug Plans for Group Retirees:

To be eligible, they must meet the criteria of at least one of the following two groups (1) and/or (2).

1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D
2. You have at least three of the following conditions:
  - Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
  - Chronic congestive heart failure (CHF)
  - Diabetes
  - Hypertension (high blood pressure)
  - Dyslipidemia (high cholesterol)
  - Mental Health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
  - End-stage renal Disease (ESRD)
  - Bone Disease-Arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
  - Alzheimer’s Disease
  - Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
3. You must be likely to spend $1,623 or more in 2025 on prescription medications covered by Medicare Part D
You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid Services (CMS) guidelines.

For EmblemHealth VIP Medicare Advantage Prescription Drug Plans:

To be eligible, you must meet the criteria of at least one of the following two groups (1) and/or (2).

1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D
2. You have at least three of the following conditions:
  1. Chronic Heart Failure (CHF)
  2. Diabetes
  3. Hypertension (high blood pressure)
  4. Dyslipidemia (high cholesterol)
  5. Osteoporosis
3. You must be likely to spend $5,330 or more in 2024 on prescription medications covered by Medicare Part D
You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid (CMS) guidelines.

For EmblemHealth Prescription Drug Plans for Group Retirees:

To be eligible, they must meet the criteria of at least one of the following two groups (1) and/or (2).

1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D
2. You have at least three of the following conditions:
  1. Asthma
  2. Chronic Obstructive Pulmonary Disease (COPD)
  3. Chronic Heart Failure (CHF)
  4. Diabetes
  5. Hypertension (high blood pressure)
  6. Dyslipidemia (high cholesterol)
  7. Depression
  8. End-Stage Renal Disease (ESRD)
  9. Osteoporosis
3. You must be likely to spend $5,330 or more in 2024 on prescription medications covered by Medicare Part D
You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid Services (CMS) guidelines.

Helpful Information and Resources

Drug List

A drug list, also called a formulary, is a list of medicines covered by your insurance plan. Talk to your doctor or pharmacist about ways to save on copays.

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Home Delivery and Refills

Get your medicines delivered straight to your door, sometimes on the same day.

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Pharmacies

Find locations and preferred in-network pharmacies where you can save on prescription drugs.

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Additional Pharmacy Information

Learn more about what our over-the-counter debit card covers, how to get money back for a drug, and more.

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