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.
Memo Contract Year 2023 Medication Therapy Management (MTM) Program Submission (v.04.15.22) (PDF)
Memo Contract Year 2022 Medication Therapy Management (MTM) Program Submission (v. 08.31.21) (PDF)
Memo Contract Year 2021 Medication Therapy Management (MTM) Program Submission (v. 05.22.20) (PDF)
MTM Contact List (v01.18.23) (ZIP)
MTM Program Standardized Format and Technical Instructions (v2.22.2022) (ZIP)