Privacy Policy Part D

Part D Medication Therapy Management


Call Us

Tennessee Residents call 866-643-6924 (TTY 711)
Alabama Residents call 855-540-4744 (TTY 711)
7 Days a Week, 8am - 8pm, Local Time

Depending on your health conditions and circumstances, you may be invited to participate in a program designed for your specific health and pharmacy needs. Participation is optional and you may choose not to participate. This program offers participants direct access to qualified health care professionals who will help them better manage their health and health care expenses. The Medication Therapy Management program is free for eligible members and is not considered a benefit. You can click here to find more information about the Medication Therapy Management program or visit medicare.gov. 
 

What are the goals of the program?

  • Educate members about their medications
  • Encourage member to take medications as prescribed 
  • Identify and prevent medical complications related to medication therapy

Who is eligible for the Medication Therapy Management Program (MTM)? 

Individual members eligible for the MTM services must meet all three (3) criteria below:
  • Have at least two (2) of the following chronic conditions: diabetes, chronic obstructive pulmonary disease (COPD), asthma, hypertension, dyslipidemia, chronic heart failure (CHF), osteoporosis, osteoarthritis, HIV/AIDS, cardiovascular disease or depression.
  • Have claims for a minimum of six (6) different chronic/maintenance Part D covered medications.
  • Are likely to incur a minimum threshold of $3,967.00 (in 2018) and $4,044.00 (in 2019) in annual drug costs for covered Part D medications.

How do eligible members enroll?

Members are encouraged to return the participation form in the envelope provided or call the toll free number provided below (depending on state of residence), 5 Days a Week, 8am to 8pm, to speak with a pharmacist regarding their medications. Participation in the program is voluntary.

Tennessee Residents call 866-643-6924 (TTY 711)
Alabama Residents call 855-540-4744 (TTY 711)
7 Days a Week, 8am - 8pm, Local Time

How do enrolled members decline participation in the program?

Enrolled members may opt out of the program by calling the toll free number provided below depending on state of residence. Members may refuse or decline individual services without having to disenroll from the program.

Tennessee Residents call 866-643-6924 (TTY 711)
Alabama Residents call 855-540-4744 (TTY 711)
7 Days a Week, 8am - 8pm, Local Time

What services does the MTM provide?

The MTM services include the following interventions for members and prescribers.
  • An annual comprehensive medication review (CMR) which includes an interactive, person-to-person consultation via the telephone between the member and pharmacist or nurse.
  • Quarterly targeted medication reviews completed electronically based on prescribed medications. Members' prescribers are sent an intervention letter to identify specific medication-related problems, a necessary change in therapy, or other opportunities to optimize medication use. The prescriber should assess the potential risk and contact the member or dispensing pharmacy directly if a change in therapy is warranted. A MTM program representative will follow up with members and/or prescribers when necessary.
  • Drug utilization reviews are completed online in real-time by the dispensing pharmacy. A real-time online pharmacy adjudication system scans all incoming prescription claims against the medication history of beneficiaries enrolled in the Medication Therapy Management program to look for potential medication related problems. The dispensing pharmacist receives a message identifying an intervention opportunity and performs the intervention through discussion with either the member and or with the prescriber as appropriate.

What happens once members are enrolled in the program?

Members will be offered a Comprehensive Medication Review (CMR) with a pharmacist or nurse. Upon completion of the CMR members will receive an individualized written summary of the CMR including a personal medication list and medication action plan in the standardized formats required by CMS.

Upon completion of the CMR, the prescriber may receive contact from the pharmacist via telephone, mail, or facsimile to resolve medication-related problems or optimize medication therapy.
Please click here to download a Personal Medication List. 

Members should refer to their Evidence of Coverage (EOC) for more details on the MTM.


 

 

Members Health Insurance Company/Farm Bureau Health Plans is a PDP plan with a Medicare contract. Enrollment in Members Health Insurance Company/Farm Bureau Health Plans contract depends on contract renewal. This information is not a completedescription of benefits. For more information, Tennessee residents call 1-866-643-6924 and Alabama residents call 1-855-540-4744. TTY users should call 711.

Last Modified: 10/11/2018 at 10:16:37 AM
S2668_CMWSFL19093 Accepted 9/27/18