Medication Therapy Management

Our plan provides a free benefit to select members called Medication Therapy Management (MTM). This program is designed to improve medication use and coordinate care between members, providers, and pharmacists. Each member eligible for MTM is entitled to a telephonic consultation with a specially-trained clinical pharmacist called a Comprehensive Medication Review. At the end of this review, the pharmacist sends a letter to the member’s primary care physician summarizing drug therapy problems and corresponding proposed recommendations derived from evidenced-based guidelines. The physician is asked to reply to the fax with which recommendations will be implemented for the member. 

Members who meet the ite​ms on the list below may be eligible for the MTM Program:

 

  • Must have three or more of the following illnesses:
    1. Chronic Heart Failure (CHF)
    2. Diabetes Mellitus
    3. Dyslipidemia (High Cholesterol
    4. Hypertension (High Blood Pressure
    5. Mental Health – Depression
    6. Mental Health – Chronic and Disabling
    7. Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD)
    8. Respiratory Disease - Asthma
  • Must fill six or more chronic Part D prescriptions per month for medications.
  • Must exceed yearly prescription costs of $3,016. Medication cost will be based on previous quarter amount greater than $754.

Members who qualify for the MTM will be automatically enrolled and will get a letter in the mail. They will have the opportunity to decline.

 


​