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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 help members understand their medications, how their medications work, what to do about medication side effects, and whether other less expensive medications may be an option.

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 at least eight (8) different chronic/maintenance Part D covered medications.
  • Are likely to incur at least a threshold of $ 3,967.00 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) between 10:00 a.m. and 6:00 p.m. Eastern Standard Time, Monday through Friday (except major holidays) 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 a letter about any specific medication problems, where, there may be a safety issue or where other medications may work better for a condition. The prescriber is asked to review whether a change is needed and then to contact the member or pharmacy directly if a change in therapy is needed. 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 a person to person review of your medications completed over the telephone with a pharmacist or nurse. The appointment usually takes about thirty (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 (1.866.484.3953 or TTY users call 711, 24 hours a day, 7 days a week; when prompted, enter your opt-out personal security PIN). 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 understanding about how to take medications as prescribed
  • 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 10/1/2017.

Y0079_7833 CMS Approved 10172017