Part D MTM Targeting Criteria Check (Diseases, Drugs and Cost Threshold)
Whether a member meets the Part D medication therapy management targeting criteria.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Plan year
- 2026
- Plan minimum number of chronic diseases
- 3
- Plan minimum number of Part D drugs
- 8
- Member chronic diseases that the plan counts
- 3
- Member Part D drugs that the plan counts
- 9
- Projected annual covered Part D drug cost
- 2400 dollars
- At-risk beneficiary under a drug management program
- No
Result: Meets the MTM targeting criteria for 2026.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Plan year
- Plan minimum number of chronic diseases (2 or 3)
- Plan minimum number of Part D drugs (2 to 8)
- Member chronic diseases that the plan counts
- Member Part D drugs that the plan counts
- Projected annual covered Part D drug cost
- At-risk beneficiary under a drug management program
- MTM cost threshold, for a year after 2027
How this is calculated
Citation
42 CFR 423.153(d)(2): MTM targeting by chronic diseases (a sponsor may require at most 3), Part D drugs (at most 8) and a cost threshold, or at-risk beneficiary status. CMS contract year 2025, 2026 and 2027 MTM program memos: thresholds of $1,623, $1,276 and $1,340. Read the sources: 42 CFR 423.153 ↗, CMS MTM memo, contract year 2027 ↗, CMS MTM memo, contract year 2026 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.