Medication Therapy Management(MTM) for Plan Year 2025

Can I get help managing my prescriptions (Medication Therapy Management MTM)?

Central Health Medicare Plan Medication Therapy Management (MTM) program is a service provided at no cost. MTM is not considered a benefit and is offered to members that meet certain criteria. A pharmacist or other trained health care provider will review your prescription, over-the-counter (OTC) and supplement/herbal medications with you over the phone or in person at your local pharmacy. The goal of MTM is to help you understand your medicines, resolve side effects and answer questions you may have about your medication.

How do I Qualify for MTM?

Central Health Medicare Plan determines MTM eligibility on a quarterly basis using medical and pharmacy claims information. You qualify for MTM if you meet each of the three criteria below:

1. Have three or more of the following conditions:

• Alzheimer's Disease
• Bone Disease-Arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
• Chronic Heart Failure (CHF)
• Diabetes
• Dyslipidemia
• End-stage renal disease (ESRD)
• Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)
• Hypertension
• 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)

2.Take at least eight maintenance Part D drugs

3. Are likely to incur annual costs for covered Part D drugs equal to or greater than $1,623 in 2025

In addition to the above criteria, you may also qualify if you are taking certain pain management medications.

Once you meet the criteria, you will be automatically enrolled in the MTM program and mailed a letter with information about the program and how to contact us. We may also call you to schedule an appointment to speak with a pharmacist.

What is discussed during my MTM consultation?

In the comfort of your own home, a pharmacist or other trained health care provider will help you:

• Review all your prescription, over-the-counter (OTC) and supplement/herbal medicines
• Discuss side affects you may have when taking certain medicines
• Answer questions you have about your medicine
• Suggest potential improvements to your medication regimen
• Make a list of your medicines with when and how you should take them
• Create goals for taking your medicine

MTM is performed over the phone and the appointment will last approximately 30 minutes. After the appointment, you will be mailed a Personal Medication List that you can share with your health care providers. You will also be mailed a Medication Action Plan that summarizes what was discussed during your MTM encounter. If the MTM provider has any concerns about your medications, such as drug interactions, your prescribing doctors will be made aware. We encourage you to participate in this Comprehensive Medication Review at least once a year and if possible, before your annual wellness visit with your doctor.

How do I contact Central Health Medicare Plan to participate in MTM?

To participate in the Medication Therapy Management Program, please call (866) 314-2427 TTY/TDD 711, 8 a.m. – 8 p.m. PST, 7 days a week (October 1 – March 31) and Monday – Friday (April 1 – September 30)