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  • Home Medicare Member Resources and Services Medication Therapy Management (MTM) Program

    Medication Therapy Management (MTM) Program

    Our Medication Therapy Management Program can help find any possible errors or gaps in your prescription drug care.

    What is the Medication Therapy Management Program?

    The Medication Therapy Management (MTM) Program is a part of Cigna HealthcareSM Medicare Part D Prescription Drug Plans and Cigna Healthcare Medicare Advantage Plans (Part C) with prescription drug coverage.

    MTM can help find any possible errors and gaps in your care by:

    • Lowering the risk of medication errors, especially if you have chronic conditions, take many medications, or see multiple doctors
    • Giving information on proven medical practices to help you and your doctor decide the most effective treatment
    • Helping you understand your condition and medications, so you can take an active role in taking care of your health

    How do I qualify?

    There are two ways to qualify for program assistance and be enrolled in the MTM program.

    The first way to qualify for program assistance is if you meet all three of the following criteria:

    1. Medical Conditions: You have at least three of the following medical conditions:

    • Diabetes
    • Dyslipidemia
    • Hypertension
    • Chronic heart failure
    • Bone disease (osteoporosis)

    2. Medications: You take at least seven drugs from selected classes:

    • Oral hypoglycemic
    • Insulins
    • Antihyperglycemics
    • Antihyperlipidemics
    • Antihypertensives
    • Angiotensin-converting-enzyme (ACE) inhibitors
    • Angiotensin II receptor blockers (ARBs)
    • Beta blockers
    • Alpha blockers
    • Calcium channel blockers
    • Diuretics
    • Bisphosphonates
    • Other metabolic bone disease agents

    3. Drug Spend Threshold: Your prescriptions for the last three months cost more than one-fourth of the yearly cost level. The Centers for Medicare & Medicaid Services (CMS) set a cost level each year. The 2024 cost level is $5,330.

    The second way to qualify for program assistance is if you are identified as an At-Risk Beneficiary (ARB) under the plan’s Drug Management Program (DMP) for potential misuse of opioid medications.

    How do I get started?

    Cigna Healthcare Medicare customers who qualify for the MTM Program are automatically enrolled1 and sent a welcome packet in the mail.

    Based on the guidelines above, all chosen customers will be offered a full comprehensive medication review (CMR) by a clinical pharmacist at least yearly. The average call time for the medication review is 20 minutes, but our pharmacists will take as much time as needed to answer all of your questions. The CMR is an interactive session with one of our clinical pharmacists to talk about all medications, such as:

    • Prescription
    • Over-the-counter (OTC) medications
    • Herbal therapies
    • Dietary supplements

    After the medication review, you'll get an individualized letter in the mail. Each letter has a personal medication record of all medications discussed and a plan of action, if needed. Your prescriber may also get a letter after your CMR with possible interventions to solve medication-related problems or other ways to optimize medication use. Also, we automatically send you a targeted medication review each quarter if eligible and mail your prescriber(s) a letter with intervention opportunities.

    Getting involved in the MTM Program may help improve your health and lower your risk for medication reactions, hospitalization, and emergency room visits. Depending on your diagnosis, it may help improve your cholesterol and blood sugar levels, and lower your risk of heart attack.

    Get a blank Personal Medication List [PDF]

    How much will this program cost me?

    There is no extra cost for this program. While it’s not seen as a Medicare benefit, the MTM Program is part of the plan you select for coverage.

    How can I safely dispose of my medications?

    It’s important to get rid of unwanted medications in a way that won’t endanger others. Drop off unwanted medications at certain authorized pharmacies and collection sites on National Prescription Drug Take Back Day or go to approved locations anytime throughout the year.

    Learn more about safe medication disposal [PDF]

    Find collection sites and approved drop-off locations

    What if I have questions?

    If you have questions or need more information, please call the Cigna Healthcare Medicare MTM Program toll-free:

    Medicare Advantage Plans (Part C)

     (TTY 711)

    Medicare Part D Prescription Drug Plans

     (TTY 711)

    Appointments are available Monday - Friday, 8 am - 5 pm ET. For questions about health plan benefits, coverage issues, or claims, please contact us.

    1 Unless you opt-out of enrolling in the program.

    The Medication Therapy Management (MTM) Program is a component of Cigna Healthcare Medicare prescription drug plans and should not be considered a Medicare benefit. MTM is neither offered nor guaranteed under our contract with the Medicare program and is not subject to the Medicare appeals process.

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    (1) the Medicare Part B Deductible;

    (2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;

    (3) any services that are not medically necessary as determined by Medicare;

    (4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;

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    Y0036_24_1037312_M | Page last updated 03/28/2024