Medication Therapy Management

We have a program that can help our members with complex health needs.

This program is voluntary and free to members. A team of pharmacists and doctors developed the program for us. This program can help make sure that our members get the most benefit from the drugs they take.  Our program is called a Medication Therapy Management (MTM) program.

Taking medications as prescribed can affect your quality of life, longevity, health outcomes, and overall healthcare costs.

(Source: "Medication Adherence: The Elephant in the Room." USPharmacist.com)

Do I qualify for medical therapy management?

Our MTM program targets members who meet all of the requirements under #1 or #2 below:

1. Must have at least 3 of the following diseases: Alzheimer's disease, high cholesterol, high blood pressure, respiratory disease (chronic obstructive pulmonary disease, or COPD), diabetes.
   ANDmust be taking a minumum of 8 Part D medications
   ANDmust incur at least $1,234 towards Part D medications, including what your insurance paid and your copayments, in the previous three months.
    
2. Members with an active coverage limitation under a Drug Management Program. 
    

How medication therapy management works

If you’re eligible for the MTM program, you’ll be automatically enrolled. Our team will reach out to let you know.

Here’s what to expect:

• You’ll first receive a welcome packet by mail within 60 days of enrollment that explains the program. We’ll then contact you by phone to see if you received the packet and would like to participate in the MTM program.
• Once you decide to participate, a pharmacist or other health professional will give you a comprehensive review of all your medications. This review is done over the phone and typically lasts 10-15 minutes. The call may be longer or shorter depending on your specific needs.
• You can talk about how best to take your medications, your costs, and any problems or questions you have about your prescription and over-the-counter medications.
• After the comprehensive medication review is complete, our pharmacists will review your therapy goals and look at your medication regimen. They will then reach out to your physician(s) to make recommendations to improve your medication therapy outcomes, if needed.
• You will also receive a written summary of this discussion in the mail. The summary has a Medication Action Plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions.
• You will also receive a Personal Medication List that will include all the medications you’re taking and why you take them.
• In addition, you will receive information on the safe disposal of prescription medications that are controlled substances.

How you can prepare

• It’s a good idea to have a list of your medications before your yearly “Wellness” visit, so you can talk to your doctor about your action plan and medication list.  To assist you we have created an easy-to-use Medication List form. 
• Bring your Medication Action Plan and Personal Medication List with you to your visit or anytime you talk with your doctors, pharmacists, and other health care providers. Also, keep your medication list with you (for example, with your ID) in case you go to the hospital or emergency room.
• Once enrolled in the MTM program, an additional service you will receive are targeted medication reviews (also known as TMRs).  These are reviews based upon specific clinical issues and are completed quarterly.  Targeted medication reviews are sent as letters and/or faxes to you and/or your prescriber regarding the information reviewed. If the specific issue is deemed to warrant additional outreach, a follow up call may be necessary to you and/or your prescriber to ensure optimum therapy is achieved. 
• It's a good idea to have your medication review before your yearly "Wellness" visit, so you can talk to your doctor about your action plan and medication list.  Bring your Medication Action Plan and Personal Medication List with you to your visit or anytime you talk with your doctors, pharmacists, and other health care providers.  Also, keep your medication list with you (for example, with your ID) in case you go to the hospital or emergency room.