Blue Medicare HMO, Blue Medicare PPO, and Blue Medicare Rx (PDP) Members
Health and Wellness
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. 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 (3) criteria below:
- Have at least three (3) of the following chronic conditions: diabetes mellitus, chronic obstructive pulmonary disease (COPD), hypertension, dyslipidemia, chronic heart failure, osteoporosis, or depression.
- Have claims for a minimum of eight (8) different, covered Part D medications.
- Are likely to incur a minimum threshold of $3,100.20 in annual drug costs for covered Part D medications.
How do eligible members enroll?
Eligible members are automatically enrolled in the program. A letter will be mailed to eligible members informing them of their enrollment in the program and inviting them to call and speak with a pharmacist regarding their medications. Participation in the program is voluntary.
What happens once you enroll in the program?
Members will be offered a Comprehensive Medication Review (CMR) with a pharmacist. After completion of the CMR, members will receive a written summary of the consultation.
How do members disenroll from the program?
Members may disenroll from the program by calling the telephone number listed in the notification letter (1-800-408-6218 or TTY/TDD at 1-800-716-3231) between 9:00 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 disenroll 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
Members should refer to their Evidence of Coverage for more details on the MTMP.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013. Please contact BCBSNC for details.
Blue Cross Blue Shield of North Carolina (BCBSNC) is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. BCBSNC is a Medicare-approved Part D sponsor. BCBSNC does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All BCBSNC items and services are available to all eligible beneficiaries in the service area.
Limitations, copayments, and restrictions 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 you would like Medicare Advantage or Part D documents in a different language or format, or your coverage has ended and you need proof of coverage or a Certification of Health Insurance Coverage, you can call us 7 days a week, 8a.m. to 8 p.m.
The information on this page is current as of 10/01/2011.
Y0079_5325 CMS Approved 10192011