Medication Therapy Management (MTM) Program

We offer a free program to help our members with their medicines. It is called the Medication Therapy Management Program, or MTM Program. Some members who take several medicines for different medical conditions may qualify for this free program.

What is the purpose of the MTM Program?

The MTM Program helps make sure that you understand how to take your medicines correctly, and addresses medicine-related problems such as side effects, use of higher-risk medicines and interactions between medicines. We can do this by talking to you about your medicines over the phone and by periodically reviewing your pharmacy claims throughout the year. We will communicate with you and your doctor if we find any medicine-related problems that we believe should be addressed.

Do you qualify for the MTM Program?

To qualify for the MTM Program, you must meet all three of the following criteria:

  • You have been diagnosed by your doctors with at least three of the following medical conditions: diabetes, high blood pressure, high cholesterol, chronic heart failure, osteoporosis, asthma, COPD or depression.
  • You have filled prescriptions for at least eight covered Part D medicines in the current calendar year.
  • You and others on your behalf (including Essence Healthcare) have paid at least $1,011 for your medicines in the previous three months.

If you are eligible for the MTM Program, we will automatically enroll you in the program and send you a welcome packet in the mail. The welcome packet includes a form you can return to us if you would like to have a medicine review phone call with an Essence Healthcare pharmacist.

What is a comprehensive medication review, and how can you request one?

We offer all of our members in the MTM Program an opportunity to review their medicines with an Essence Healthcare pharmacist or other trained healthcare provider over the phone. We call this a comprehensive medication review. If you would like to have a call, please return the comprehensive medication review form included in your welcome packet. Then we will contact you to schedule a time for the call that works best for you. If you have lost the form, you can call us and request a comprehensive medication review.

Please have a list of your medicines or your medicine bottles with you at the time of your call. This includes prescription medicines, over-the-counter medicines and supplements that you are taking.

During the phone call, we will review your medicines in detail. We can talk about how best to take your medicines, your costs and any other problems you are having with your medicines. We can also help you set health goals and make plans to accomplish those goals. We are happy to address any questions or concerns you have about your medicines. Most calls take about 20 to 30 minutes.

After the call we will send you a written summary of the discussion. The summary has a medication action plan that recommends what you can do to make the best use of your medicines, with space for you to take notes or write down any follow-up questions. You will also get a personal medication list that will include all the medications you are taking and why you take them. If you would like a copy of a blank personal medication list, please click here.

How can you get more information about the MTM Program?

If you would like more information or have questions about the MTM Program, please contact our customer service. If you misplace any letters that we have sent you, please contact us and we will send another letter. Again, there is no cost to you to participate in the Essence Healthcare MTM Program.

What if you are enrolled in MTM Program, but do not want to participate in the program?

If you receive an MTM Program welcome packet from us but do not wish to participate in the MTM Program, you can let us know by returning the Decline Participation form included in the welcome packet or by contacting us.

If you previously told us that you did not want to participate in the MTM Program, but have changed your mind and now wish to participate, please contact customer service.

This program is not considered a benefit – it is a free program for those who qualify.