Prescription Drug Information

Medication Therapy Management Program (MTM)

Medication Therapy Management Program (MTM)

We offer a full range of Pharmacy benefits to our members who are at high risk for medication-related problems. Our Medication Therapy Management (MTM) program is offered to qualified members at no cost and can help them better manage their medications.

MTM Program Eligibility

Members who have two or more of the following medical conditions, who take seven (7) or more maintenance, Part D medications, and whose total 2019 drug cost for the year is expected to be $4,044 or more, are likely to be eligible for our program.

  • Alzheimer's Disease
  • Asthma
  • Anticoagulant Therapy
  • Chronic Heart Failure
  • Chronic Lung Disorders
  • Chronic Obstructive Pulmonary Disease
  • Chronic Mental Health Conditions
  • Depression
  • Diabetes
  • Dyslipidemia
  • End-Stage Renal Disease
  • Hepatitis C
  • Hypertension
  • Multiple Sclerosis
  • Osteoarthritis
  • Osteoporosis
  • Rheumatoid Arthritis

Purpose and Benefits of the MTM Program

The goal of the program is to make sure that our members are using the appropriate medications for their health conditions. It also helps us identify possible medication problems.

Services offered as part of the MTM program are:

  • Yearly comprehensive Medication Review (CMR) with the member. This service is provided by phone.
  • Quarterly Targeted Medication Review (TMR) faxed or mailed to the prescriber(s)

This program is not a benefit. It is a voluntary program and free of charge.

Participating in the MTM Program

A member who meets the eligibility criteria listed above, will automatically be enrolled in the MTM program, which includes CMR and TMR services. The member will receive a welcome letter that gives the member the opportunity to ask additional questions, schedule a CMR, and to disenroll from all or parts of the program, if desired.

If you decide not to participate, please notify us and we will withdraw your participation from the program.

MTM Program Details

The CMR is an interactive, person-to-person consultation with a pharmacist to review prescription and over-the-counter medication regimens. The pharmacist will review each of the medications and provide consultation on the best way to use them. Any opportunity to optimize the medication regimen will be discussed with the member (or authorized representative).

The review usually takes about 30 - 45 minutes. After the review, we will mail you a summary of the discussion, a Medication Action Plan and a Personal Medication List, all of these in a CMS-approved, standardized format.

View a blank copy of the Personal Medication List document.

If you need additional information about the MTM Program or need to request any of the documents, please call Blue Shield of California Promise Health Plan Member Services at (855) 905-3825 (TTY 711) 8 a.m. - 8 p.m., 7 days a week.



Utilization Management | Quality Assurance




Material ID: H0148_19_028_WEB
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