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/ Advantage D-SNP Medication Therapy Management

Advantage D-SNP Medication Therapy Management

If you take medications for different medical conditions, you may be able to get services, at no cost to you, through a Medication Therapy Management (MTM) program. This program helps you and your provider make sure that your medications are working to improve your health. The MTM program is voluntary and available to members who qualify. You may qualify for the MTM program if you meet the specific criteria of either group below.

A doctor looking at a clipboard with a patient

How to qualify for services

Group 1:

You qualify for the MTM program if you meet all of the criteria below:

  • You have at least 3 of these chronic diseases:
    • Alzheimer’s Disease
    • Bone disease and joint inflammation
    • Chronic heart failure (CHF)
    • Diabetes
    • Dyslipidemia (high cholesterol)
    • End-stage kidney disease
    • Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
    • Hypertension (high blood pressure)
    • Mental health conditions
    • Asthma, chronic obstructive pulmonary disease (COPD), or other chronic lung disorders
  • You are taking at least 8 different maintenance medications
  • You are likely to spend at least $1,276 on covered Medicare Part D drugs in 2026

Group 2:

You qualify for the MTM program if either of the following apply to you:

  • It is determined that you are at high risk of having an adverse event or overdose because of the total dose of opioid medication(s) you take from multiple prescribers or get from multiple pharmacies; or
  • You have a recent history of opioid-related overdose.

If you qualify for the MTM program, you will be automatically enrolled in the program and mailed a welcome letter within 60 days that explains the program and how to ask for a medication review. The welcome letter will also include information about how to safely dispose of unused prescription medications. The MTM program is available to Health Plan of San Joaquin/Mountain Valley Health Plan Advantage D-SNP (HMO) members who qualify at no cost.

If you do not want to be in the MTM program, please let us know and we will remove you from the program. You can leave the program at any time.

Frequently asked questions

Will enrollment into the MTM program cost me anything?
This is a covered service for all Health Plan of San Joaquin/Mountain Valley Health Plan Advantage D-SNP members. The program is free of charge.
What are the benefits of being enrolled into the MTM program?
If you qualify to be enrolled in the MTM program, the program goals are:

    • Improved medication safety and effectiveness.
    • Personalized support for medication questions.
    • Possible cost savings from optimized therapy.
    • Assistance with adherence and lifestyle changes.

What services are being provided through this MTM program?

  • Comprehensive Medication Review (CMR)
  • Targeted Medication Reviews (TMRs)
  • Medication-related action plans
  • Coordination with healthcare providers

What can I expect during a Comprehensive Medication Review (CMR) or follow-up session?

An appointment with a pharmacist to review your entire medication regimen will occur during a CMR or follow-up session. The goal is to optimize your medications, improve your health outcomes, and reduce your risk of medication-related problems. A Medication Action Plan (MAP) will be created at the end of the call and sent to your provider to address any issues or concerns related to your medications as well.

How is an MTM appointment scheduled?

All MTM services will be performed virtually via a phone call with a licensed pharmacist.

What if I have additional questions but I don't have an appointment scheduled?

You can contact Health Plan of San Joaquin/Mountain Valley Health Plan Advantage D-SNP Customer Service at 1-888-361-7526 (TTY: 711) and request for the Pharmacy option for additional MTM services.

Need Help?
Call our Customer Service team at 1-888-361-7526 (TTY 711) from
8:00 a.m. to 8:00 p.m., seven days a week from October 1 – March 31,
& Monday – Friday, April 1 – September 30. The call is free.

HPSJ/MVHP Advantage D-SNP logo

7751 S. Manthey Road French Camp, CA 95231
1-888-361-7526 (TTY: 711)

Hours of Operation: 8:00 a.m. – 8:00 p.m.
Mon – Sun: October 1 – March 31
Mon – Fri: April 1 – September 30

 

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Posted on August 5th, 2025 and last modified on October 6th, 2025.

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