Medication Therapy Management Program (MTMP)

Our plan offers a program designed to help you manage your Part D medications, especially if you face complex health challenges. For example, if you have multiple medical conditions, you may need to take several prescription drugs to treat them effectively.

To support your care, a team of pharmacists and doctors developed the Medication Therapy Management Program (MTMP). Our program helps you and your doctor select the best medications for your conditions and ensures you get the greatest health benefit from them by:

• Preventing or reducing drug-related risks and errors
• Increasing your knowledge of the medications you take
• Encouraging healthy medication habits

The program is not a benefit. It’s an extra service that is voluntary and at no cost to members who meet the following:

• Have three or more of these medical conditions:
  • Alzheimer’s Disease
  • Bone Disease – Osteoporosis, Osteoarthritis, Rheumatoid Arthritis
  • Chronic Heart Failure
  • Diabetes
  • Dyslipidemia – High Cholesterol
  • End-Stage Renal Disease
  • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome – HIV/AIDS
  • Hypertension
  • Mental Health – Depression, Schizophrenia, Bipolar Disorder, and other chronic/disabling mental health conditions
  • Respiratory Disease – Asthma, Chronic Obstructive Pulmonary Disease
• Take eight or more chronic or maintenance Part D drugs
• Spend more than $1,276 each year on drugs

Or

• Is an At-Risk Beneficiary as defined in 42 CFR §423.100

If you meet the above criteria, we enroll you in our program automatically. From there, one of our MTMP pharmacists reviews your medication history and sends you a welcome letter. The letter describes any potential medication related problems found and invites you to call for a full review. We may also reach out to you in other ways about your medications. If you do not want us to contact you, just tell us. We will remove you from the program.

The goal is to help you reach the best results to fit your needs. If you want to continue, one of our pharmacists or pharmacy interns, under the direct supervision of a pharmacist, will connect you with the following services:

• Annual Comprehensive Medication Review (CMR). Conducted by phone or face-to-face, a CMR creates a collection of all of your medication-related information. The pharmacist will go over your medications and medical conditions and may contact your prescribing doctor. The CMR takes approximately 30 minutes, is usually offered once each year—if you qualify, and addresses concerns you may have about the medications you take, including:
  • Prescription drugs
  • Over-the-counter (OTC) medicines
  • Herbal therapies
  • Dietary supplements and vitamins
• Personal Medication List (PML). You’ll receive a list of all your prescriptions and over-the-counter medications discussed during the review. The PML can be updated as needed. Here is a Sample PML (PDF)
• Medication Action Plan (MAP). One of our MTMP pharmacists creates your MAP. It helps you follow steps in taking medications to reach your health goals. It may also include suggestions from the pharmacist for you and your doctor to discuss at your next visit.

We print your PML and MAP and either mail or hand-deliver them to you within 14 days of your CMR.

• Quarterly Targeted Medication Reviews (TMR). TMRs identify potential concerns. Our MTMP pharmacists will mail, fax or call you and your doctor with suggestions about drug therapies that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them.

A review with a pharmacist is very important when more than one doctor prescribes medications without full knowledge of your complete medication list, including over-the-counter (OTC) drugs.  During your review, a pharmacist will:

• Discuss how your prescription and OTC medications may interact with each other.
• Explain any side effects and suggest ways to manage or avoid them.
• Help you  get the most benefit from all of your medications, including prescriptions and OTC products.
• Identify opportunities to reduce your prescription drug costs.

A personalized medication review can give you peace of mind and help you take your drugs in a safe and effective way. If you want to take part in our program but need help, you can choose someone to act on your behalf. Your MTMP pharmacist will work with any authorized team members to help you reach your health goals.

If you would like to talk with a pharmacist about your medications, or if you do not want to take part in our program, please call Express Scripts toll-free at 1-855-931-2782 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. Central Standard Time (CST).

Members in this program may receive a call from The Healthy Living Program, MedWatchers, or a local Pharmacist.

Medication Therapy Management Program (MTMP)

Our plan has programs that help you manage your Part D medications in special situations. For example, you may have several complex medical conditions. If so, you may need to take many prescription drugs to treat those conditions. You also could have high drug costs.

A team of pharmacists and doctors developed a program to help members like you with your healthcare. This is called the Medication Therapy Management Program, or MTMP. Our MTMP pharmacists help you and your doctor choose the drugs that work best to treat your medical conditions. They also help you get the greatest health benefit from your medications by:

• Preventing or reducing drug-related risks (and errors)
• Increasing your awareness
• Supporting good habits

The program is not a benefit. It’s an extra service that is voluntary and at no cost to eligible members who:

• Have three or more of these medical conditions:
  • Alzheimer’s Disease
  • Bone Disease – Osteoporosis, Osteoarthritis, Rheumatoid Arthritis
  • Chronic Heart Failure
  • Diabetes
  • Dyslipidemia – High Cholesterol
  • End-Stage Renal Disease
  • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome – HIV/AIDS
  • Hypertension
  • Mental Health – Depression, Schizophrenia, Bipolar Disorder, and other chronic/disabling mental health conditions
  • Respiratory Disease – Asthma, Chronic Obstructive Pulmonary Disease
  • Or, is an At-Risk Beneficiary as defined in 42 CFR §423.100
• Take eight or more chronic or maintenance Part D drugs
• Spend more than $1,623 each year on drugs

If you meet the above criteria, we enroll you in our program automatically. From there, one of our MTMP pharmacists reviews your medication history and sends you a welcome letter. The letter describes any potential medication related problems found and invites you to call for a full review. We may also reach out to you in other ways about your medications. If you do not want us to contact you, just tell us. We will remove you from the program.

The goal is to help you reach the best results to fit your needs. If you want to continue, one of our pharmacists or pharmacy interns, under the direct supervision of a pharmacist, will connect you with the following services:

• Annual Comprehensive Medication Review (CMR). Conducted by phone or face-to-face, a CMR creates a collection of all of your medication-related information. The pharmacist will go over your medications and medical conditions and may contact your prescribing doctor. The CMR takes approximately 30 minutes, is usually offered once each year—if you qualify, and addresses concerns you may have about the medications you take, including:
  • Prescription drugs
  • Over-the-counter (OTC) medicines
  • Herbal therapies
  • Dietary supplements and vitamins
• Written Summary. Within 14 days of the CMR, you'll receive a standardized post CMR takeaway letter which includes a "Recommended To-Do List" detailing the conversation with the MTM provider, a Personal Medication List (PML), and may contain medication safe disposal information.  Sample Medication List (PDF)

• Quarterly Targeted Medication Reviews (TMR). TMRs identify potential concerns. Our MTMP pharmacists will mail, fax or call you and your doctor with suggestions about drug therapies that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them.

A review with a pharmacist is important. Different doctors may write prescriptions for you without knowing all the prescriptions and/or OTC medications you take. For this reason, a pharmacist will:

• Discuss how your prescription and /or OTC medications may affect each other.
• Explain how your prescription and/or OTC medications may cause side effects and offer suggestions.
• Help you get the most benefit from all of your prescription and/or OTC medications.
• Review opportunities to help reduce your prescription drug costs.

Reviewing your medications with a pharmacist can result in real peace of mind and the knowledge you need to take medications safely. If you want to participate in our MTMP but need assistance, you can authorize someone on your behalf. Your MTMP pharmacist can work with other authorized team members to help you reach your health goals.

If you would like to talk with a pharmacist about your medications, or if you do not want to participate after being enrolled into the program, please call Express Scripts toll-free at 1-855-931-2782 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. Central Standard Time (CST).

Qualified members may receive a call from The Healthy Living Program, MedWatchers, or a local Pharmacist.