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Important Legal Information and Disclaimers

Blue Medicare HMO, Blue Medicare PPO, and Blue Medicare Rx (PDP) Members

Health and Wellness

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Medication Therapy Management Program

Members enrolled in Blue Medicare HMOsm or Blue Medicare PPOsm with Medicare prescription drug benefits or Blue Medicare RXsm may be eligible for the medication therapy management program (MTMP), in accordance with CMS requirements. Medication Therapy Management Services are designed to help members understand their medications, improve medication use to optimize outcomes, and reduce the risk of adverse drug events.

Who's Eligible for the MTMP?
Individual members eligible for the MTMP services must meet all three (3) criteria below:

  • Have at least three (3) of the following chronic conditions: diabetes, chronic obstructive pulmonary disease (COPD), hypertension, dyslipidemia, chronic heart failure (CHF), or rheumatoid arthritis.
  • Have claims for a minimum of eight (8) different chronic/maintenance Part D covered medications.
  • Are likely to incur a minimum threshold of $ 3,919.00 in annual drug costs for covered Part D medications.

How do eligible members enroll?
Eligible members are automatically enrolled in the program. A letter and participation form will be mailed to eligible members informing them of their enrollment in the program. Members are encouraged to return the participation form in the envelope provided or call a toll-free phone number (1-866-686-2223 or TTY users call 711 or 1-800-855-2881) to speak with a pharmacist regarding their medications. Participation in the program is voluntary.

What services does the MTMP provide?
The MTM services include the following interventions for members and prescribers.

  • An annual comprehensive medication review (CMR) with a pharmacist to review prescription and non-prescription medications. Pharmacists will work with you and your prescribers to solve any medication issues and help you get the best results.
  • Quarterly targeted medication reviews (completed electronically based on prescribed medications). Members' prescribers are sent an intervention letter about any specific medication related problems, a necessary change in therapy for safety, or other opportunities to optimize medication use. The prescriber is asked to assess the potential risk and to contact the member or dispensing pharmacy directly if a change in therapy is warranted. The MTMP will follow up with members and/or prescribers when necessary

What is a Comprehensive Medication Review (CMR)?
A Comprehensive Medication Review (CMR) is an interactive review of your medications completed over the telephone with a pharmacist or nurse. The appointment usually takes about 30 minutes and during that time the pharmacist will:

  • Review the medicines you take
  • Create a personal medicine list
  • Help you understand how your medicines work
  • Tell you about side effects from your medicines
  • Answer any questions or concerns you have

How do members opt out (decline) participation in the program?
Members may opt out from participating in the program by calling the telephone number listed in the notification letter (1-866-686-2223 or TTY users call 711 or 1-800-855-2881) between 10:00 a.m. and 6:00 p.m. Eastern time, Monday through Friday (except major holidays). Members may also refuse or decline individual services without having to opt out from the program.

What are the program goals?

  • Educate members regarding their medications
  • Increase adherence to medication therapy
  • Identify and prevent medical complications related to medication therapy

For more information regarding MTMP and a Personal Medication list from a CMR standardize format, please click on the following:

Members should also refer to their Evidence of Coverage for more details on the MTMP. These programs are not considered a benefit.

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Important Legal Information and Disclaimers

The information on this page is current as of 10/1/2016.

Y0079_7520 CMS 10042016