Medication Therapy Management

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. 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
2. 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. 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
2. You are a good candidate for the Drug Management program based on the Centers for Medicare and Medicaid Services (CMS) guidelines.