Medicare Advantage

Medication Therapy Management

Keeping you on track.

Program overview.

This program helps you and your provider(s) make sure your medications are effective and identify and reduce possible problems or adverse interactions. St. Luke’s Advantage contracts with Judi Rx for MTM Services. Judi Rx partners with Outcomes® for member outreach.

To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a plan benefit.

If you meet program criteria, we will send you a letter inviting you to participate in the MTM program. Your enrollment is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

Eligibility criteria.
To qualify, you must meet one of the two following criteria:

  1. Be considered at highest risk of adverse events or overdose related to opioid use and part of our Drug Management Program or
  2. Meet all of the following criteria:
  • Have at least three of the following conditions or diseases:
    • Alzheimer's Disease
    • Chronic Heart Failure
    • Diabetes
    • End-stage renal disease
    • Dyslipidemia
    • HIV/AIDS
    • Hypertension
    • Chronic and Disabling Mental Health Conditions (Including depression, schizophrenia and bipolar disorder)
    • Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD) and other chronic lung disorders)
    • Bone Disease or Arthritis (including osteoporosis, osteoarthritis and rheumatoid arthritis)
  • Take at least eight covered Part D medications, and
  • Spending $1,340 or more in 2027 for Part D covered medications.
Clinical review.
To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:
  1. Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, your caregiver, your pharmacist and/or your provider if we detect a potential problem. This is a good time to ask any questions you have about your medications. If you have trouble remembering to take your medication, the pharmacist may be able to suggest ways to help you stay on track. If there are concerns about the dose or safety of a medication, the pharmacist will ask your permission to talk with your provider to find the best solution for you.
  2. Comprehensive medication review: at least once per year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. The pharmacist will meet with you face-to-face or via phone to review your prescriptions, vitamins, herbals, supplements and other over-the-counter medications. The pharmacist looks for potential medication conflicts, duplications, side effects as well as potential ways to save you money. After the review, the pharmacist will work with you and your provider to resolve any medication-related concerns. The estimated time commitment is about 15-30 minutes and you will get a written summary of the call, which includes:
    • Recommended steps you should take to help you get the best results from your medications.
    • Personal medication list to help you keep track and how to use them the right way.

 If you take many medications for more than one chronic health condition and have questions about MTM, please call the Outcomes Patient Engagement Team at 855-905-4689 (TTY: 711) Monday through Friday, 8am to 6pm CST.

FAQs

How do I opt out of this program?

How do I safely dispose unused medications?