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Medication Therapy Management

Guidance for Part D sponsors regarding information related to Part D Medication Therapy Management (MTMP) program requirements and information.

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: May 27, 2020

This section contains information related to Part D Medication Therapy Management (MTM) Program requirements and information.

Requirements for Medication Therapy Management (MTM) Programs: Under 423.153(d), a Part D sponsor must have established a MTM program that:

  • Ensures optimum therapeutic outcomes for targeted beneficiaries through improved medication use
  • Reduces the risk of adverse events
  • Is developed in cooperation with licensed and practicing pharmacists and physicians
  • Describes the resources and time required to implement the program if using outside personnel and establishes the fees for pharmacists or others
  • May be furnished by pharmacists or other qualified providers
  • May distinguish between services in ambulatory and institutional settings
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)

Each Part D Sponsor is required to incorporate a Medication Therapy Management (MTM) Program into their plans' benefit structure.  Annually, Sponsors must submit a MTM Program description to CMS for review and approval.  A CMS-approved MTM Program is one of several required elements in the development of a Sponsor's bid for the upcoming contract year.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.