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 is 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.
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 Cross and Blue Shield of North Carolina (BCBSNC) is a Medicare Advantage organization with a Medicare contract to provide HMO and PPO plans. BCBSNC does 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 is an independent licensee of the Blue Cross and Blue Shield Association.