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Medication Therapy Management Program

We have programs to help members with their Part D medications in special conditions. Some members have several complex medical conditions at one time. These members may need to take many drugs at the same time. These members also could have high drug costs. A team of pharmacists and doctors created a program for us to help these members with their care. The program is called the Medication Therapy Management program, or MTMP.

The MTMP helps make sure our members are using the drugs that work best to treat their conditions. The MTMP helps us find possible medication errors. The MTMP helps with better drug adherence. The program is not a benefit. There is no cost for members who qualify. There is no pressure from the plan to join.

Members who are eligible for the MTMP have:

  • Three or more of the following chronic disease states:
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Hypertension or High Blood Pressure
    • Dyslipidemia or High Cholesterol
    • Osteoporosis
    • End Stage Renal Disease (ESRD)
    • Mental Health-Depression
    • Diabetes
  • Eight or more chronic or maintenance Part D medications
  • High drug costs (more than $3,967 each year)

If you meet the requirements for the MTMP, we will enroll you in the program. An MTM pharmacist will review your medication history and we will send you a welcome letter telling you that you have qualified for the MTMP. We will also inform you of any issues that were identified by the pharmacist. The letter will tell you to expect a call to schedule your drug review.  You can also call to ask for a drug review.

If you do not want to be in the program, tell us. We will withdraw your name from the program.

We will provide the following MTMP services with a final goal of helping the enrolled members reach the best therapeutic results to fit their needs.  The pharmacist or pharmacy intern supervised by a pharmacist may work with other medical team members to help the member reach their health goals.

  • An annual Comprehensive Medication Review (CMR) is done either by phone or a face-to-face meeting. This CMR is to gather a list of drugs the member is using. Any medication concerns will be addressed. The CMR will take no more than 45 minutes.
  • A Personal Medication List (PML) will be offered to record all prescription and over-the-counter medications. The list can be updated as often as needed (sample PML - PDF).
  • A Medication Action Plan (MAP) will be formed to help members follow steps while taking their drugs. This MAP will be created after the CMR meeting to reach health goals.
  • The PML and MAP are printed and either hand delivered or mailed within 14 calendar days of the Comprehensive Medication Review.
  • Targeted Medication Reviews (TMR) will take place quarterly. This review will find possible safety concerns. Some drugs are not advised for those over age 65. The review may offer other drug therapies that may help the member. The member may be asked to talk with their doctor.  A letter may be sent to the doctor.

A family member or friend can take part in the MTMP for the member. The authorized representative form must be completed by the member for this person. 

If you have questions about this program, or need assistance, please call Member Services at 1-877-941-0482. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and holidays, you may leave a message. Your call will be returned within the next business day. TTY users call 711. The call is free.

 

 

Last Updated: 02/08/2018
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