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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 is eligible for the MTMP?
Individual members eligible for the MTMP services must meet all three criteria below:

Have multiple chronic diseases, such as diabetes, chronic obstructive pulmonary disease, hypertension, hyperlipidemia, and congestive heart failure, must have filled multiple Part D covered medications, and are likely to incur annual costs for covered Part D medications that exceed $4,000 annually.

How will eligible members be identified?
Targeted members will be identified by the Pharmacy Benefit Manager (PBM) through prescription claims information. The PBM will provide a list of identified and eligible members to PARTNERS.

Medicare beneficiaries who meet the criteria below will be identified for MTMP services:

• Have at least 2 chronic conditions, with at least 2 of the following: Hypertension, High Cholesterol, Congestive Heart failure, Diabetes, Chronic Obstructive Pulmonary Disease
• Have claims for at least 5 different, covered Part D medications during a 12-month period or less based on receipt of claims data (both chronic and acute medications are considered in the evaluation process) and
• Will be likely to incur a minimum threshold of $4,000 in annual drug costs for covered Part D medications.

How do eligible beneficiaries enroll?
Eligible members not already participating in a care or disease management program will be contacted by a nurse for possible participation in the program. 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 in the program?

• Members who agree to participate will receive a phone call by a nurse. Services available include medication education, safety, adherence, and review of medical condition associated with the medication therapy.
• Members will have the option of speaking directly with a plan pharmacist, as appropriate.
• The member and or prescribing physician(s) will be notified of potential adverse drug events and interactions, and patterns of over-use or under-use of medication.
• Members may receive educational materials via the mail.

What are the goals of the program?

• Educate members regarding their medications
• Increase adherence to medication therapy
• 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 11/4/08.