Medication therapy management

Who is eligible for UPMC for Life's medication therapy management program?

2024
You will be automatically enrolled in UPMC for Life's MTM program if you meet the following criteria:

• You have three or more of the following chronic diseases (based on claims data):
  • Asthma
  • Chronic congestive heart failure (CHF)
  • Diabetes
  • High cholesterol
  • HIV/AIDS
  • High blood pressure
  • Osteoporosis
  • Rheumatoid arthritis
• AND have eight or more chronic/maintenance Part D covered drugs within a 90-day period,
• AND are likely to incur annual costs that meet or exceed $5,330 for all covered Part D drugs. (UPMC for Life estimates that members whose drug costs equal or exceed $1,332.50 in a 90-day period will have an annual drug cost of at least $5,330.)

You may also be enrolled in the Medication Therapy Management program if you have been identified as an At-Risk Beneficiary (ARB) in our Drug Management Program.

2025

You will be automatically enrolled in UPMC for Life's MTM program if you meet the following criteria:

• You have three or more of the following chronic diseases (based on claims data):
• Alzheimer’s disease
• Bone disease-arthritis (osteoporosis, osteoarthritis, and rheumatoid arthritis)
• Chronic congestive heart failure (CHF)
• Diabetes
• High cholesterol
• End-stage renal disease (ESRD)
• HIV/AIDS
• High blood pressure
• Mental health (depression, schizophrenia, bipolar disorder, and chronic/disabling mental health conditions)
• Respiratory disease (asthma, chronic obstructive pulmonary disease, and chronic lung disorders)
• AND have eight or more chronic/maintenance Part D covered drugs within a 90-day period,
• AND are likely to incur annual costs that meet or exceed $1,623 for all covered Part D drugs. (UPMC for Life estimates that members whose drug costs equal or exceed $405.75 in a 90-day period will have an annual drug cost of at least $1,623.)

You may also be enrolled in the Medication Therapy Management program if you have been identified as an At-Risk Beneficiary (ARB) in our Drug Management Program.

What happens after I am enrolled in UPMC for Life's Medication Therapy Management program?

When you become eligible for the Medication Therapy Management program, you will receive a welcome letter that:

• Notifies you of your enrollment in the program.
• Provides instructions on how to schedule a CMR.
• Provides instructions on how to opt out of the MTM program.

Members who do not respond to the letter may receive automated phone calls, calls from a pharmacy representative, text messages, and/or emails to schedule a CMR. Members in the MTM program may also receive phone calls from a registered nurse, social worker, and/or case manager.