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Medication Therapy Management Program

Provider Type

  • Physicians (does not apply to Cal MediConnect)
  • Participating Physician Groups (PPG)

As part of the Medicare Part D prescription medication benefit, the Centers for Medicare and Medicaid Services (CMS) mandates that all Part D plans provide a Medication Therapy Management (MTM) program. Health Net's program offers an integrated approach to promoting safe, effective medication use and improving medical outcomes.

Eligibility Criteria

Members who meet all of the following criteria may be enrolled in Health Net's MTM:

  • Currently enrolled in a Health Net Medicare Part D plan and
    • Have three or more of the following chronic diseases: chronic obstructive pulmonary disease (COPD), diabetes, depression, dyslipidemia, end-stage renal (ESRD) or osteoporosis.
    • Are taking eight or more chronic Part D medications.
    • Likely to incur an annual total prescription medication cost in excess of $3,967 for 2018 ($4,044 for 2019).

Members enrolled in a Health Net Special Needs Plan (SNP) who do not meet the criteria listed above are enrolled in the MTM program and receive quarterly targeted medication reviews by a pharmacist each calendar year, and may call to speak with an MTM program pharmacist.

Program Description

MTM pharmacists evaluate member's medication profiles and send out customized letters to members and faxes to providers with information about potential medication-related problems. Members are encouraged to discuss the recommendations with their providers, or community or MTM pharmacists. Members continue to be referred to Health Net's case management program and other wellness programs. For additional information, providers can contact the Health Net MTM program. 

Last Updated: 10/30/2019