For Health Plans and Pharmacy Benefit Managers (PBMs), ensuring CMS compliance is essential to the success and effectiveness of their Medication Therapy Management (MTM) programs. Meeting these guidelines not only guarantees the provision of quality care but also fosters better patient outcomes. In this blog post, we will explore steps that Health Plans and PBMs can take to meet CMS requirements for their MTM programs and how leveraging RxMTM+ can streamline the process.

Step 1: Understanding CMS Requirements

The first and foremost step is to have a comprehensive understanding of CMS guidelines for MTM programs. This includes reviewing all relevant documentation, updates, and changes to ensure full compliance. Health Plans and PBMs must familiarize themselves with the criteria for eligible beneficiaries, the frequency of required medication reviews, documentation standards, and reporting requirements.

Step 2: Building a Robust MTM Program

Creating a robust MTM program is crucial for CMS compliance. This involves defining clear objectives, establishing standard operating procedures, and developing protocols to identify and engage eligible beneficiaries. Health Plans and PBMs should focus on creating patient-centric care plans that address individual medication needs, support adherence, and minimize drug-related problems.

Step 3: Implementing Advanced MTM Technology – RxMTM+

Integrating a cutting-edge MTM software like RxMTM+ can significantly streamline the compliance process. RxMTM+ offers a suite of features designed to meet CMS requirements effectively. The software provides medication reconciliation tools, identifies drug interactions, generates comprehensive reports, and ensures accurate documentation, making it easier for organizations to maintain compliance.

Step 4: Identifying Eligible Beneficiaries

Accurate identification of eligible beneficiaries is essential to meet CMS requirements. RxMTM+ can help Health Plans and PBMs identify potential candidates based on criteria such as chronic conditions, multiple medications, and high-risk profiles. By targeting the right individuals, organizations can efficiently allocate resources and maximize the impact of their MTM interventions.

Step 5: Conducting Comprehensive Medication Reviews

CMS requires periodic medication reviews for eligible beneficiaries. RxMTM+ simplifies this process by providing a user-friendly platform for healthcare professionals to conduct comprehensive reviews of patients’ medication regimens. The software flags potential issues and generates actionable recommendations, enabling healthcare providers to devise personalized care plans efficiently.

Step 6: Ensuring Adherence Monitoring

Adherence monitoring is a critical aspect of CMS compliance. RxMTM+ offers adherence tracking and reporting capabilities, enabling Health Plans and PBMs to monitor patient compliance with prescribed medications. This feature helps identify non-adherent patients early on and allows healthcare professionals to intervene promptly to improve adherence rates.

Step 7: Providing Targeted Interventions

CMS emphasizes the importance of targeted interventions to address specific medication-related problems. RxMTM+ facilitates targeted interventions by offering real-time clinical alerts and notifications. This feature enables healthcare providers to intervene proactively in case of drug interactions, duplications, or other medication issues, thereby improving patient safety and adherence.

Step 8: Generating CMS-Compliant Reports

Accurate and timely reporting is essential to demonstrate compliance with CMS requirements. RxMTM+ simplifies the reporting process by automatically generating CMS-compliant reports. These reports provide a detailed overview of the MTM program’s performance, patient outcomes, and adherence rates, enabling Health Plans and PBMs to assess program effectiveness and make data-driven improvements.


Meeting CMS requirements for Medication Therapy Management programs is vital for Health Plans and Pharmacy Benefit Managers to deliver high-quality care and improve patient outcomes. By understanding the guidelines, building a robust MTM program, and leveraging advanced technology like RxMTM+, organizations can streamline their compliance efforts effectively. RxMTM+ offers a comprehensive solution, from identifying eligible beneficiaries to conducting medication reviews and generating CMS-compliant reports. With RxMTM+, Health Plans and PBMs can optimize their MTM programs, ensuring better patient care, improved adherence, and ultimately driving positive health outcomes for their beneficiaries. Embrace the power of RxMTM+ and take a significant step towards CMS compliance and enhanced MTM program success. Click here to schedule a live demo of RxMTM+.

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