What MTM is
Medication Therapy Management is a set of pharmacist-delivered services designed to optimize therapy and reduce medication-related problems for individual patients. In Medicare it is a requirement: every Part D plan sponsor must operate an MTM program for targeted high-risk, high-cost enrollees under federal regulation (42 CFR 423.153(d)). Enrollment uses an opt-out design, so eligible beneficiaries are auto-enrolled at no cost and may decline.
The two reviews: CMR and TMR
Two services anchor a Part D MTM program:
- Comprehensive Medication Review (CMR) is an interactive, real-time, person-to-person or telehealth review of all of a patient's medications, including prescription, over-the-counter, herbal, and supplements, conducted by a pharmacist or qualified provider. CMS requires it be offered at least once every 365 days, and it produces a standardized written summary with a Personal Medication Record and a Medication Action Plan.
- Targeted Medication Review (TMR) is a narrower review of a specific drug-therapy problem, required at least quarterly, with follow-up to the patient or prescriber as needed.
The professional framework behind MTM has five core elements: a medication therapy review, a personal medication record, a medication-related action plan, intervention or referral, and documentation with follow-up.
Who qualifies for MTM
A Part D plan must target a beneficiary who meets all three CMS criteria: multiple chronic diseases, multiple covered Part D drugs, and annual Part D drug costs at or above a cost threshold. For 2025, CMS revised the methodology to equal the average annual cost of eight generic drugs and set the threshold at $1,623, a sharp drop from prior years. The change, driven in part by the Inflation Reduction Act's redesign of the Part D benefit, roughly doubled the share of enrollees who qualify, from about 7% to 13%, and CMS added HIV/AIDS to its list of core chronic diseases.
MTM and Star Ratings
The MTM program completion rate for the CMR is a long-standing Part D quality measure, stewarded by the Pharmacy Quality Alliance. Completion has historically been low, and a common industry response was to narrow whom plans deemed eligible rather than to deliver more reviews. The measure is on the display page for measurement years 2025 and 2026 and is scheduled to return as a Star Ratings measure for measurement year 2027. With a larger eligible population and a fixed 365-day clock, completing CMRs is a sizable operational task that maps directly to adherence and Star performance.
How Pelica runs MTM at scale
The bottleneck in MTM is execution, not strategy: identifying who is eligible, reaching them, scheduling the review, and completing it inside the window. Pelica's Pharmacy and Part D copilot identifies and prioritizes eligible members, runs outreach and scheduling, and surfaces the drug-therapy problems a reviewer should act on, so plans complete more reviews instead of shrinking the denominator. CMRs surface the non-adherence and gaps that feed the triple-weighted adherence measures, where Pelica customers hold 96% adherence.
Related terms
See medication adherence and PDC for the measures MTM supports, and triple-weighted measures for why those measures dominate the Part D score.