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Personal Medication Lists

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If you're part of our Medication Therapy Management program, you'll need to send us a list of the drugs you're taking. Find the form here.

Our Medication Therapy Management program makes sure all the drugs certain members are taking are working safely and effectively.

This form helps our team of doctors and pharmacists catch any problems or gaps with the medications you're taking. If we find an issue, we'll contact you or your doctor.

We'll identify members who may be at risk for drug-related issues, and send them information about the MTM Program. Enrolling in the MTM program is free, voluntary, and doesn't affect your drug coverage under Medicare.


Click below for your personal medication list:

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Page Last Updated Tue Jul 08 15:50:57 EDT 2014