Medication Therapy Management Program Process

Catamaran’s Medication Therapy Management (MTM) program ensures you are receiving the most effective medications, while also helping to reduce the risk of side effects and interactions as well as decrease out-of-pocket costs.The program is paid in full by your plan. This means that you can receive the benefits of the MTM program at no cost to you. There is no change to insurance benefits, co-pays, prescription coverage, or available doctors or pharmacies.

The MTM program is designed to help members who meet the below criteria to get the most from their medications:

  • You must have 2 or more chronic diseases from the following eight disease states: Asthma, Chronic Obstructive Pulmonary Disease (COPD), Depression, Diabetes, High Cholesterol, Heart Failure, HIV, High Blood Pressure, Osteoporosis, Rheumatoid Arthritis
  • You must have filled 4 or more Part D maintenance or chronic medications
  • Likely to incur a yearly drug spend of $3,144 or more

Members who meet the program criteria are sent an introduction letter which describes the MTM program. Specially trained pharmacists work closely with you and your doctors to solve any problems related to your medications and to help you get the best results.You will also be contacted by a specially trained pharmacist for a brief medication consultation to review all of your medications and answer any questions that you may have.

Following the consultation, the pharmacist will provide you with a medication review package which contains several helpful documents all related to your medication therapy and consultation. A Personal Medication List template and a Medication Action Plan template are available for your reference at the links below.

Medication reviews are offered once a year, but may occur more frequently as you are diagnosed with new disease states or start new medications.

Medicare requires that MTM programs automatically enroll those who qualify throughout the calendar year, but participation is voluntary, and you have the opportunity to opt out at any time.Once you have been enrolled, you will remain enrolled through the calendar year unless you opt-out or leave our plan.

If you have any questions about the MTM program, please call Catamaran’s MTM Department at 1-866-352-5305. (TTY users dial 711), Monday - Friday, 8 am to 8 pm CST.