Medication Therapy Management

MTM-eligible members are automatically enrolled in the program, sent an introductory letter, and will receive a phone call welcoming them to the program, providing the opportunity to opt-out or request a Comprehensive Medication Review (CMR).

Members may opt out or request a CMR by returning an enclosed appointment form or calling the toll-free number provided. Members who request a CMR have a telephone appointment scheduled for a one-on-one consultation with a pharmacist, or licensed pharmacy intern under the direct supervision of a pharmacist.

During the CMR, the member's entire medication profile is reviewed (including prescriptions, over-the-counter drugs (OTCs), herbal supplements, and samples) for appropriateness of therapy. Disease-specific goals of therapy and medication-related problems are discussed with the member, as well as any member-specific questions.

After the CMR, the member is mailed the standardized post-CMR takeaway letter, which includes a Personal Medication List (PML) and Medication Action Plan (MAP) detailing the conversation with the pharmacist, or licensed pharmacy intern. Meanwhile, all members who have not opted out of the program receive ongoing Targeted Medication Reviews (TMRs) on at least a quarterly basis with each update of prescription claims.

Be sure to print a blank copy of the Personal Medication List (PML) for your own use.

TMRs identify opportunities for interventions based on systematic drug utilization review including:

• Cost savings
• Adherence to national consensus treatment guidelines
• Adherence to prescribed medication regimens
• Safety concerns

TMRs that result in the generation of alerts are categorized and prioritized based on the severity of the alert. The member or doctor would then be contacted in person, or via phone call, text, mail, e-mail, electronic data exchange, or fax as appropriate for review of potential drug therapy changes.

TMR alerts that result in an outbound phone call to the member allow an additional opportunity to offer the member a CMR. Members who accept the CMR on the outbound TMR call receive the CMR as outlined above. Interventions resulting from person-to-person TMRs, non-person-to-person TMRs, and CMRs may result in provider contact in person, or via fax, phone, text, email, electronic data exchange, or mail, when appropriate.