To be eligible in 2025, you must meet the criteria of at least one of the following two groups (1) and/or (2). 

1. 1. You take eight or more prescription medications for ongoing conditions covered by Medicare Part D 
      
   2. You have at least three of the following conditions:
      • Diabetes
      • Chronic congestive heart failure (CHF)
      • Dyslipidemia (high cholesterol)
        
      • Hypertension (high blood pressure)
      • Alzheimer’s Disease
      • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
      • End-stage renal disease (ESRD)
      • Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
      • Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
      • Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
   3. You must be likely to spend $1,623 or more in 2025 on prescription medications covered by Medicare Part D.
2. You have been identified as an at-risk beneficiary (ARB) — that is, you currently have an active coverage limitation under our Drug Management Program (DMP) in one or both of the sections below. 
   • Level of opioid use from multiple prescribers and pharmacies:
     • Use of opioids with average daily Morphine Milligram Equivalents (MME) greater than 90 mg for any duration during the most recent 6 months AND either:
       • 3 or more opioid prescribers AND 3 or more opioid dispensing pharmacies; OR
       • 5 or more opioid prescribers (regardless of the number of opioid dispensing pharmacies)
     • Prescribers associated with the same single Tax Identification Numbers (TIN) are counted as a single prescriber.
     • Pharmacies with multiple locations that share real-time data are counted as one pharmacy.
   • History of opioid-related overdose:
     • A medical claim with a primary diagnosis of opioid-related overdose within the most recent 12 months; AND
     • A Part D opioid prescription, not including Medication Assisted Treatment, within the most recent 6 months.

To participate in the MTM Program, you must be eligible. If you qualify, we will automatically enroll you at no additional cost. We will mail you a letter and may follow up with a phone call and/or an email or text message inviting you to participate and providing information about the program. Participation is voluntary. You can opt out of the program at any time, but we hope you can take advantage of this opportunity to get the most from your medications.

There is no added cost for this program. While not considered a Medicare benefit, the MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is a special service that is part of your Medicare plan. The goal is to help you get the maximum benefit from your medications.

To find out more about the MTM Program, you can call ConnectiCare's Medicare Pharmacy Services toll-free at 888-830-6831 (TTY: 711) from 9 a.m. to 5 p.m., Monday through Friday.

You will:

• Receive a welcome letter in the mail and may receive a phone call and/or text from us with information on how to get started.
• Be invited to complete a full medication review with a ConnectiCare clinical pharmacist over the phone. During this review, the pharmacist will go over your medical conditions and medications including prescriptions, over-the-counter drugs, herbal therapies, and dietary supplements to make sure they are safe and working for you. The pharmacist can also talk to you about possible ways to save money on your medications. The review may take up to 15 to 20 minutes.
• Receive a personal medication list and medication action plan in the mail. Your personal medication list will help you keep track of your medications and how to use them the right way. Your medication action plan will have steps to help you get the best results from your medications. Be sure to share this information with your doctor.
• Your medications can be reviewed every four months via a targeted medication review. After each review, we may send your doctor a letter explaining any issues or ways to improve. Your prescriptions will not change unless you and your doctor decide to change them.
• Get helpful information on how to safely dispose of prescription drugs that are controlled substances, including opioids, at home and through takeback programs.

You and your health care providers can also keep track of the medications you are taking with a blank Personal Medication List.

We want to be sure you understand your medications and how to take them. We will answer any questions or concerns you may have.