Medication Therapy Management

How does UPMC for Life help members who take many medications?

UPMC for Life members who have multiple chronic diseases, take many medications regularly and have an expensive drug therapy regimen may need some help managing their medications. UPMC Health Plan has developed a Medication Therapy Management (MTM) program at no additional cost to you. The program is administered by a team of health care professionals, including pharmacists, registered nurses, social workers, and case managers.

Members who meet the three criteria listed above are automatically enrolled in this free program. You don’t have to do anything. You can disenroll at any time if you would like by calling our Pharmacy Clinical Operations Department at 1-866-778-6073 Monday through Friday between 8 a.m. and 4:30 p.m. TTY users should call 1-800-361-2629. The program includes:

  • Monthly targeted medication reviews to look for problems, such as drug interactions, duplications in drug therapy, and gaps in care.
  • Letters and phone calls to prescribers to inform them of potential drug-related issues.
  • An annual Comprehensive Medication Review (CMR). This is a person-to-person conversation between the member and a pharmacist. A CMR provides education about medications, and identifies and corrects any drug related problems or concerns. After the CMR, members receive a medication action plan and person medication list in the mail. These materials are sent out within a week of completing the CMR review. View a blank copy of the personal medication list.

What are the criteria for a member to be eligible for the Medication Therapy Management program?

A member must meet the following criteria to be eligible for UPMC’s medication therapy management program:

  • The member must have three or more of the following 17 chronic diseases: Diabetes, Asthma, Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF), Hypertension, Dyslipidemia, Cardiovascular Disease, Dementia, End Stage Renal Disease (ESRD), HIV/AIDS, Multiple Sclerosis, Osteoporosis, Transplant, Rheumatoid Arthritis, Parkinson’s disease, Schizophrenia, and Alzheimer’s disease.
  • The member must have filled eight or more chronic/maintenance Part D covered drugs within a 90-day period.
  • The member must be likely to incur annual costs that meet or exceed the following amounts for Part D drugs:
    • For 2016, members must meet or exceed $3,507.00 for all covered Part D drugs. (UPMC estimates members who will have an annual drug cost of at least $3,507.00 by selecting members whose drug costs equal or exceed $876.75 in a 90-day period.)
    • For 2017, members must meet or exceed $3,919.00 for all covered Part D drugs. (UPMC estimates members who will have an annual drug cost of at least $3,919.00 by selecting members whose drug costs equal or exceed $979.75 in a 90-day period.)

Eligible members will be contacted by letter to:

  • Notify them of their enrollment in the program.
  • Provide instructions on how to schedule a CMR.
  • Provide instructions on how to opt out of the MTM program.

Members who do not respond to the letter will receive an interactive automated phone call and/or a call from a pharmacist to schedule a CMR. Members in the MTM program may also receive phone calls from registered nurses, social workers, and/or case managers.

Please note: This program is not considered a benefit. For more information regarding the UPMC for Life Medication Therapy Management program, please call our Pharmacy Clinical Operations Department at 1-866-778-6073 Monday through Friday between 8 a.m. and 4:30 p.m. TTY users should call 1-800-361-2629.

Premium, copays, and coinsurance may vary based on the level of Extra Help you receive. Please contact the plan for further details. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

UPMC for Life Dual is available to anyone who has both Medical Assistance (Medicaid) from the state and Medicare. UPMC for Life Dual is an HMO SNP plan with a Medicare contract and a contract with the Pennsylvania Medical Assistance (Medicaid) program. Enrollment in UPMC for Life Dual depends on contract renewal. UPMC for Life Dual is a product of and operated by UPMC for You Inc.

UPMC for Life Options is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and/or resides in a nursing home. Premiums, copayments, coinsurance, and deductibles may vary based on the level of Extra Help you receive. UPMC for Life Options is an HMO SNP plan with a Medicare contract. Enrollment in UPMC for Life Options depends on contract renewal. UPMC for Life Options is a product of and operated by UPMC Health Plan Inc.


We are available to take your call:
Toll-free: 1-866-405-8762
TTY: 1-866-407-8762
seven days a week 8 a.m. to 8 p.m.*

*Our hours of operation change twice a year.

Oct. 1 – Feb. 14:
seven days a week 8 a.m. to 8 p.m.

Feb. 15 – Sept. 30:
Monday through Friday 8 a.m. to 8 p.m.


Y0069_18_1123 Approved

Last Updated: 10/01/2017
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