You might qualify for the MTM program if you meet the rules for one of the two groups below. The MTM program is not a benefit for SFHP Care Plus.

Group 1: You qualify for the MTM program if you meet all the rules 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:

• You are considered to be at high risk for serious side effects or overdose because you are taking a high amount of opioid medicine(s). This may be due to getting prescriptions from more than one doctor or filling them at different pharmacies; or
• You have a recent history of opioid-related overdose.
• If you qualify for the MTM program, you’ll be signed up automatically. You’ll get a welcome letter in the mail that explains how the program works and how to ask for a review of your medications. The letter will also tell you how to safely get rid of any unused prescription drugs. The MTM program is free for SFHP Care Plus members who qualify.

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.

If you meet the criteria for the MTM program, you will be automatically enrolled in the program. You will receive a welcome letter for the MTM program. The letter will explain the program and tell you how to ask for review of your medications with a pharmacist or other health care professional, called a Comprehensive Medication Review (CMR).

To schedule your CMR, complete and return the form you received with your welcome letter in the postage-paid envelope. This review is most helpful if it can be completed before you see your provider for your annual wellness visit.

CMR is a one-on-one telephone conversation between you or your authorized representative and a pharmacist or other health professional. During the CMR, the pharmacist reviews all the medications you take, including prescriptions, over-the-counter drugs (OTC), herbal supplements, and samples. The pharmacist writes down on a Personal Medication List (PML) how to take your medications and explains why you take each medication.

You also discuss the goals of taking your medications and any problems or questions you may have. Please allow at least thirty minutes for your CMR. The time required to review all your medications depends on many factors, and it may take longer. After the CMR, you will receive a follow-up letter that includes a Medication Action Plan detailing your conversation with the pharmacist, along with your Personal Medication List.

Even if you do not complete a CMR, the MTM program will review your medications every three months as part of a Targeted Medication Review (TMR). TMRs help to identify specific or potential problems from your medications. If we find any issues with the drugs you are taking, we may contact you, your authorized representative, or your doctor.

Yes. After a review is completed, you will get a written summary of this discussion. The summary has a Medication Action Plan that recommends what you can do to make the best use of your medications. You will also get a Personal Medication List that will include all the medications you take and why you take them.