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
This 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:
- Enfermedad de Alzheimer
- Enfermedad ósea: osteoporosis, osteoartritis, artritis reumatoide
- Chronic Heart Failure
- Diabetes
- Dislipidemia: colesterol alto
- Enfermedad renal en etapa terminal
- Virus de la inmunodeficiencia humana/Síndrome de inmunodeficiencia adquirida (VIH/SIDA)
- Hipertensión
- Salud mental: depresión, esquizofrenia, trastorno bipolar y otras afecciones de salud mental crónicas o incapacitantes
- Enfermedad respiratoria: asma, enfermedad pulmonar obstructiva crónica
- Toma ocho o más medicamentos de mantenimiento o para tratar afecciones crónicas de la Parte D
- 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, you are placed into our program. You may receive a welcome letter or a phone call inviting you to complete a Comprehensive Medication Review (CMR). We may also contact you through other means about your medications. If you prefer not to be contacted, simply let us know and we will remove you from our program.
The goal of our program is to help you achieve the best possible health outcomes tailored to your needs. If you choose to take part, one of our pharmacists or pharmacy interns (under the direction of a pharmacist) will provide the following services:
- Annual Comprehensive Medication Review (CMR). We conduct each review by phone or in person, the CMR gathers all your medication-related information. The pharmacist will review your medications and medical conditions and may also contact your doctor. The CMR typically takes about 30 minutes, is offered once per year (if you qualify), and will address any concerns about the medications you take, including:
- Medicamentos recetados
- Medicamentos de venta libre (OTC)
- Terapias herbales
- Suplementos dietéticos y vitaminas
- Written Summary. Within 14 days of the CMR, you’ll receive a standardized letter after the CMR which includes a “Recommended To-Do List “ detailing the conversation with the MTM provider, a Personal Medication List (PML) (Sample PML- PDF), and may contain information about safe medication disposal.
- Quarterly Targeted Medication Reviews (TMR). TMRs identify potential concerns. Our MTMP pharmacists will mail, fax, or call you and your doctor to suggest drug treatment options that may be safer, or work better than your current drugs. As always, your doctor will decide what is best for you and your health. 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.
