OBJECTIVES:  To explore consumers’ decision making on using government-promoted Comprehensive Medication Review (CMR) service and factors affecting the uptake of CMRs among elderly residents in Iowa. METHODS:  Semi-structured personal interviews were conducted among a purposive sample of 13 elderly residents in Iowa. Participants were recruited through either a local pharmacy or a registry of seniors maintained by University of Iowa, if they were 65 years or older and used medication(s) with Medicare Part D coverage. An interview guide informed by a conceptual framework in consumer behavior was developed, including domains of internal need, external influence, perceived risk in service use, and alternative comparison. Interview data were audio-recorded, transcribed and thematically analyzed, using MaxQDA. RESULTS:  Five of thirteen participants received CMRs previously, and three of the eight non-recipients would like to receive one in the near future. The thematic analysis yielded four themes: CMR-recipients’ experiences, consumers’ perceived reasons for CMRs use, consumers’ perceived reasons for no CMRs use, and promotion strategies for increasing CMR-uptake. Overall, CMR-recipients were highly satisfied with their CMR process and results. Perceived reasons for using CMRs included: seeking knowledge of personal medications, recommendation from pharmacists or physicians, and being worried about medication safety. Main perceived reasons for not using CMRs were poor awareness or understanding of CMRs, complete trust on physicians, and privacy concerns. Recommendation from either physicians or pharmacists was considered the most effective promotion approach to increase CMR-uptake. CONCLUSIONS:  Consumers who received CMRs expressed a positive attitude toward them. However, awareness of CMRs remains low after being available for 7 years. Safety worriers or knowledge seekers appear more likely to use CMRs while physician believers or privacy worriers are more likely to not use CMRs. Recommendations from health professionals and understanding of service benefits were identified as factors affecting consumers’ decision making for using CMRs.