Blue Medicare HMO, Blue Medicare PPO, and Blue Medicare Rx Members
Health and Wellness
Medication Therapy Management Program (MTMP)
Members enrolled in a Blue Medicare HMO or Blue Medicare PPO with Medicare prescription drug benefits may be eligible for the medication therapy management program (MTMP), in accordance with CMS requirements. The purpose of the program is to provide medication therapy management services to targeted members. These services are designed to ensure that covered Part D drugs are appropriately used to optimize therapeutic outcomes by improving medication use and reducing the risk of adverse drug events including adverse drug interactions. The MTMP is developed in cooperation with licensed and practicing pharmacists and physicians.
Who's eligible for the MTMP?
Individual members eligible for the MTMP services must meet all three criteria below:
- Have at least three (3) chronic conditions: diabetes, chronic obstructive pulmonary disease, hypertension, dyslipidemia, congestive heart failure, osteoporosis, and depression.
- Have claims for a minimum of eight (8) different, covered Part D medications.
- Will be likely to incur a minimum threshold of $3,000 in annual drug costs for covered Part D medications.
How do eligible members enroll?
Eligible members are mailed a letter explaining the services and inviting them to call and speak with a pharmacist for counseling. Participation in the program is voluntary.
Members already participating in a care or disease management program will receive information about the program at the next scheduled contact by the disease or care manager.
What happens once you enroll?
Members who agree to participate may receive counseling and education services such as medication reviews, drug education, enhancing medication adherence, identifying health and safety issues and reducing drug adverse events, and addressing cost savings opportunities.
What are the program goals?
- Educate members about their medications
- Increase following medication therapy as prescribed
- Identify and prevent medical complications related to medication therapy
Members should refer to their Evidence of Coverage for more details on the MTMP.
Blue Medicare HMO and Blue Medicare PPO plans are offered by PARTNERS National Health Plans of North Carolina, Inc. (PARTNERS), a subsidiary of Blue Cross and Blue Shield of North Carolina (BCBSNC). PARTNERS is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. Plans are administered by BCBSNC. BCBSNC and PARTNERS do not discriminate based on color, gender, religion, national origin, age, race, disability, handicap, sexual orientation, genetic information, source of payment or health status as defined by the Centers for Medicare & Medicaid Services (CMS). All qualified Medicare beneficiaries may apply. You must be entitled to Medicare Part A and enrolled in Medicare Part B and must reside in the CMS-approved service area. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or another third party. BCBSNC and PARTNERS are independent licensees of the Blue Cross and Blue Shield Association.
The information on this page is current as of 10/01/2009.