Member Resources

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a MTM program. MTM is a service offered by Simpra Advantage at no additional cost to you! MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.

What is the Medication Therapy Management (MTM) program?
The MTM program is a service offered by Simpra Advantage at no additional cost to you. It is required by the Centers for Medicare and Medicaid Services (CMS). It is not part of your pharmacy benefit.

How do I participate in this program?
To participate, you must meet certain criteria. These are used to identify people who have many chronic diseases and are at risk for related problems. If you meet these criteria, we will send you a letter inviting you to take part in the program. We will also send you information and provide instructions to access the program. Your enrollment in MTM is voluntary. It does not affect Medicare coverage for drugs covered under Medicare. If you do not want to be in the program, please let us know and we’ll take you out of the program. You can leave the program at any time.

 To qualify for Simpra Advantage MTM program, you must meet the requirements for at least one of the following two groups:

Group 1:  Have at least three of the following conditions or diseases:

• Alzheimer’s Disease
• Bone Disease (osteoporosis, osteoarthritis, rheumatoid arthritis)
• Congestive Heart Failure
• Diabetes
• Dyslipidemia
• End-Stage Renal Disease
• HIV/AIDS
• Hypertension
• Mental Health (depression schizophrenia, bipolar disorder, other chronic/disabling mental health conditions)
• Respiratory Disease (asthma, chronic obstructive pulmonary disease [COPD], other chronic lung disorders)

AND Takes at least eight cover Medicare Part D medications. 

AND Are likely to have greater than $1,623 per year in covered Medicare Part D medication costs.

OR

Group 2: Are enrolled in the Simpra Advantage Drug Management Program as an At-Risk Beneficiary (ARB). This program helps our members safely use their prescription opioid medications, and other medications that are frequently abused.

What services does the MTM program offer?

To help reduce the risk of possible problems, our MTM program offers two types of clinical review:

• Targeted medication review: At least every three months, we will review all your prescription medications and may contact your doctor if we identify a potential problem.
  
• Comprehensive medication review (CMR): At least once per year, we offer a free discussion and review of all your medications by a clinician or other health professional to help you use your medications safely. This service is provided to you confidentially on behalf of Simpra Advantage via telephone by a Navitus Clinical Engagement Center clinician. The CMR may also be provided in person at your provider’s office, pharmacy, or long-term care facility.
  

The process takes about 20-30 minutes of your time. Afterwards you will receive a written summary of the CMR, which can be helpful when you talk with your doctors. It includes:

• Recommended To-Do-List (TDL) (also known as Medication Action Plan (MAP)): The TDL has steps you should take to help you get the best results from your medications
  
• Personal Medication List (PML): The PML will help you and your health care providers keep track of your medications. It explains how to use your medications the right way.
  

To obtain a blank copy of the Personal Medication List (PML) that can help you and your health care providers keep track of the medications you are taking, click here 2025 Personal Medication List

Next Steps

If you take many medications and for multiple chronic health conditions, please contact us to see if you’re eligible. You can call the Navitus Medication Therapy Management (MTM) program team at 1-888-913-7885, Monday through Thursday 8 a.m. to 7 p.m. Central Time and on Friday 8 a.m. to 5 p.m. Central Time. TTY users can reach our program team through the National Relay Service 711, during the same hours as shown above.