Medication Management Therapy Program

If you are a member who takes many prescription drugs, or who has high drug costs or chronic diseases, you could be eligible for the Samaritan Advantage Health Plan HMO Medication Therapy Management Program, also known as MTM. This is a free service for eligible members.

2023 Qualifications

To qualify for MTM, members must meet the following criteria:

• Must be taking a minimum of eight drugs covered by Medicare Part D
• Must have a prescription drug spend that is greater than or equal to $4,660 per calendar year
• Must have a minimum of three chronic diseases that Samaritan Advantage has chosen to monitor, as permitted by the Centers for Medicare & Medicaid Services (CMS):
  • Bone disease/arthritis/osteoporosis.
  • Chronic heart failure, also known as CHF.
  • Diabetes.
  • Mental health/depression.
  • Respiratory disease/asthma.
  • Respiratory disease/chronic obstructive pulmonary disease, also known as COPD.
  • HIV/AIDS.

Program Details

Each eligible MTM member’s drug information is analyzed for potential drug-drug interactions, possible adverse effects of medications, or gaps in care. Every quarter, we automatically enroll qualified members in our MTM program so they may begin receiving this extra support. Eligible MTM members will receive a letter notifying them that they have been auto-enrolled into the MTM Program.

As an MTM member, you are also eligible to receive a comprehensive medication review. We will offer participation by mail and in some cases by phone. The comprehensive medication review will give you the opportunity to review all of your current medications with a pharmacist. This is a one-on-one conversation by phone that takes about 30 minutes.

After completing the review, you will be mailed a personal medication list and a medication action plan. The list will include your current prescription medications, over-the-counter medications and dietary and herbal supplements. The medication action plan will summarize what you and the pharmacist discussed during the medication review and discussion topics for you and your provider. We will also conduct ongoing Targeted Medication Reviews and your provider may be contacted by mail if we identify any issues with your medications.

Members who meet the MTM criteria are requested to participate in the program. Members are allowed to decline this service at any time during the contract year. During the contract year, members may enroll in the MTM if they still meet the criteria.

The MTM is not a benefit, but a service provided by Samaritan Advantage. Members are encouraged to contact the plan’s Customer Service Department at 800-832-4580 (toll free) or TTY 800-735-2900 daily from 8 a.m. to 8 p.m.

For more information about safe disposal of prescription drugs that are controlled substances, please visit Controlled Substance Public Disposal Locations – Search Utility. More information about prescription drug take-back sites will be updated as soon as it becomes available.