Prescription Benefits Medication Therapy Management

Medication Therapy Management

If you have complex health needs, you may be eligible to participate in our Medication Therapy Management (MTM) program. This program helps you and your doctor make sure that your medications are working. MTM programs include a free discussion and review of all of your medications by a pharmacist or other health professional to help you use them safely. You will get a summary of this discussion to help you get the most benefit from your medications. You can have this summary available when you talk with your doctors or other health care providers.

HNE, in collaboration with our Pharmacy Benefit Manager, National Pharmaceutical Services (NPS), offers a MTM Program at no additional cost to our members. Our MTM Program targets those members who meet the following criteria:

• Minimum of 3 chronic diseases, including: Chronic Heart Failure, Diabetes, Dyslipidemia, Hypertension, Depression, Chronic Obstructive Pulmonary Disease
• 8 or more Part D medications and
• Drug costs that exceed an annual cost is expected to exceed $3,507

The following are features of the MTM Program:

• Enhances the member’s understanding through education and interventions that promote the appropriate use of the medications, and reduces the risk of potentially adverse events associated with the use of the medication
• Increases member adherence to prescription medication regimens by providing refill reminders, compliance programs
• Promotes detection and reduction of adverse drug events such as falls, mental confusion and delirium, and patterns of overuse and underuse of prescription drugs
• Offers health risk assessments, prescription drug treatment plans, managing high cost specialty medications and evaluating and monitoring patient response to drug therapy.
• Sends communications to prescribers discussing medication risks and suggested alternatives or corrective therapy recommendations.

Once enrolled, members receive quarterly mailings and newsletters in addition to a welcome enrollment kit. Materials focus on disease education, wellness and prevention, proper medication utilization, proper diet and exercise as well as lifestyle modifications. Members also receive written materials when interventions or other opportunities are noted and include refill reminders and cost savings opportunities.

The MTM Program is not considered a Medicare benefit. It is available at no additional fee to those beneficiaries who meet the criteria above. The program is voluntary and beneficiaries can opt out at anytime. Although you don’t have to participate, it is recommended that you take full advantage of this free service if you are selected.

If you take many medications for more than one chronic health condition and would like to see if you are eligible or if you simply wish to get additional information regarding our MTM Program, contact NPS, using one of the phone numbers listed below under “Prescription Drug Questions.” Also, refer  the MTM Reference sheet here.

Personal Medication List

Even if you don’t participate in the MTM Program, it still is a good idea to create a Personal Medication List. While your doctor may have a list of your medications in his or her files, you might be seeing more than one doctor. Having a Personal Medication List can reduce your medication risks and prevent medical errors. It may also help you and your caregivers keep track of what drugs you need to take.

• Print the form and list all: prescription medications, over-the-counter drugs, herbals, vitamins, and minerals.
• Record any drug allergies or side effects you have.
• Keep this list up-to-date:
  • Use blank rows to add new medications. Then fill in the dates you started using them.
  • Cross out medications when you no longer use them. Then write the date and why you stopped using them.
  • Ask your doctors, pharmacists, and other healthcare providers to update this list at every visit.
• Keep the list in your wallet or purse. If you go to the hospital or emergency room, take this list with you. Share this list with your family or caregivers, too.

H8578_2016_049 Approved
The information on this page was last updated on 2/18/2016