Medication Therapy Management Medicare: Free Reviews Your Parent May Qualify For

Medicare Part D includes a benefit most families never hear about: Medication Therapy Management (MTM). It provides a free, pharmacist-led review of your parent's entire medication regimen — catching dangerous interactions, unnecessary drugs, and missed treatments. The problem is that qualifying patients are often never told they're eligible.

MTM Eligibility: Three Criteria

Under federal regulation 42 CFR § 423.153(d), every Medicare Part D plan must offer MTM to enrollees who meet all three criteria:

1. Multiple chronic conditions. The plan can require two to three chronic diseases from a list of ten: Alzheimer's disease, bone disease/arthritis, chronic heart failure, diabetes, dyslipidemia, end-stage renal disease, HIV/AIDS, hypertension, mental health disorders, and respiratory disease. Most seniors on multiple medications will meet this threshold.

2. Multiple Part D drugs. Plans can set the threshold between two and eight concurrent maintenance medications. All Part D maintenance medications count toward the total.

3. High annual drug costs. Your parent's projected annual drug spending (plan-paid plus out-of-pocket) must meet or exceed the CMS threshold, which is adjusted annually. This calculation includes both the plan's share and your parent's copayments.

Additionally, any beneficiary enrolled in a Drug Management Program (DMP) as an at-risk beneficiary is automatically eligible for MTM.

What the Review Includes

Eligible enrollees receive an annual Comprehensive Medication Review (CMR) — a real-time, interactive consultation with a pharmacist or qualified provider. This isn't a form letter. It's a one-on-one discussion (in person or by telehealth) covering every medication your parent takes.

If your parent has cognitive impairment, the review can be conducted with you as their caregiver, their prescriber, or an authorized representative.

After the review, the provider must send two standardized documents:

• Medication Action Plan (MAP): Specific recommended changes — drugs to stop, doses to adjust, interactions to resolve
• Personal Medication List (PML): A complete record of active drugs, doses, indications, and stop dates

Beyond the annual CMR, plans must perform quarterly Targeted Medication Reviews (TMRs) to catch new drug therapy problems that emerge between annual reviews.

How to Get the Review Started

Step 1: Call your parent's Medicare Part D plan. The number is on the back of their insurance card. Ask specifically: "Is my parent enrolled in the Medication Therapy Management program?" Plans must automatically enroll qualifying members, but you should confirm.

Step 2: If they qualify, request the CMR. Ask whether it can be scheduled by phone or telehealth for convenience. If your parent is cognitively impaired, explain that you'll be participating as their caregiver.

Step 3: Prepare before the call. Compile a complete list of every medication (prescription, OTC, supplements), recent lab results (especially kidney function), and any symptoms that started after beginning a medication. The more organized you are, the more productive the review.

Step 4: After the review, make sure you receive the MAP and PML documents. These are your roadmap for follow-up appointments with your parent's doctors.

Beyond Medicare: Other Free Review Programs

If your parent doesn't qualify for MTM or lives outside the US:

• UK: NHS Structured Medication Reviews through GP surgeries, prioritized for patients on 10+ medications
• Canada (Ontario): MedsCheck — free pharmacist review for anyone on 3+ chronic medications with a valid OHIP card
• Canada (BC): PharmaCare medication reviews for patients on 5+ qualifying medications
• Australia: Home Medicines Reviews recommended every 24 months

The Understanding and Managing Polypharmacy toolkit includes a free medication review program guide covering eligibility criteria across all major jurisdictions, plus preparation worksheets so your parent gets the most out of every review.