Medication therapy management

For Medicare Advantage plan members in Illinois and Missouri

If you’re in a Medicare Advantage plan of ours and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM helps you and your prescriber make sure that your medications are working. It also helps identify and reduce possible medication problems.

The MTM program is a service offered by us at no additional cost to you. These services are provided in line with CMS guidelines and are not considered a benefit.

How do I participate in this program?

You will be automatically enrolled in this program if you meet the three requirements below.

1. Have at least three of the following conditions or diseases:

• Alzheimer's Disease
• Arthritis/Osteoporosis
• Chronic heart failure (CHF)
• Diabetes
• Dyslipidemia
• End-Stage Renal Disease (ESRD)
• Hypertension
• Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
• Mental Health (including depression, schizophrenia, and bipolar disorder)
• Respiratory Disease (Asthma and Chronic Obstructive Pulmonary Disorder (COPD))

2. Take at least eight covered Medicare Part D medications.

3. Are likely to have greater than $6,492 per year in covered Medicare Part D medication costs.

You will be automatically enrolled in this program if you are in a drug management program that defines a specific drug dose, pharmacy or doctor.

What services does the MTM program offer?

To help reduce the risk of possible problems, our MTM program offers two types of clinical review:

• Targeted medication review: At least every three months, we will review all of your prescription medications and may contact your doctor if we detect a potential concern. These may be related to safe drug use or even ways to lower your drug cost.
• Comprehensive medication review (CMR): At least once a year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. This review is offered through a partnership between us and the Navitus Clinical Engagement Center. The MTM program helps you and your doctor make sure that your medicines are working to improve your health. The CMR may also be provided in person at your provider's office, pharmacy, or long-term care facility.
  
  The process takes about 20 minutes of your time. Afterwards you will receive a written summary of the CMR, which can be helpful when you talk with your doctors. It includes: 
  1. Medication Action Plan (MAP): The MAP has steps you should take to help you get the best results from your medications. A blank version is available in English and Spanish. 
  2. Personal Medication List (PML): The PML will help you and your health care providers keep track of your medications. It explains how to use your medications the right way. A blank version is available in English and Spanish.

Next steps

If you meet these criteria, we will send you a letter informing you that you qualify and are automatically enrolled in the program. This letter will include general information about the MTM program, provide instructions to contact the MTM program and how to opt-out. If you would like more information about this program or you do not wish to take part in the MTM program, please call Member Services at 1-877-301-3326 (TTY: 711).