Privacy Policy Part D

Part D Medication Therapy Management

Call Us

Tennessee Residents call 844-368-8738 (TTY 711)
Alabama Residents call 844-368-8739 (TTY 711)
7 Days a Week, 8am - 8pm

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 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 844-368-8738 (TTY 711)
Alabama Residents call 844-368-8739 (TTY 711)
7 Days a Week, 8am - 8pm

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 844-368-8738 (TTY 711)
Alabama Residents call 844-368-8739 (TTY 711)
7 Days a Week, 8am - 8pm

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.


FIND A PHARMACY NEAR YOU

Once enrolled, you’ll have access to more than 67,000 pharmacies. Click here to find a pharmacy.

You may also use a pharmacy that is not in our network. However, if you go to a pharmacy outside the network, you may have to pay more for your prescriptions, and you may have to file a claim to be reimbursed. You will be responsible for payment of any difference between the non-network pharmacy’s charge and the amount the plan allows. Some drugs may have quantity limits or other restrictions that apply.

If you would like to request a printed copy of the pharmacy directory please call the toll free number below depending on state of residence, 8am-8pm, 7 days a week.

Tennessee Residents call 844-368-8738 (TTY 711)
Alabama Residents call 844-368-8739 (TTY 711)
7 Days a Week, 8am - 8pm

LEARN MORE ABOUT MEDICARE’S HELP PROGRAM: LOW INCOME SUBSIDY

Medicare beneficiaries with limited incomes may qualify for the Medicare Part D “Extra Help” program. This is also known as the Low Income Subsidy (LIS) program. 

The program was created by the Social Security Administration to help people with limited incomes pay for prescription drugs. If you qualify for Medicare Part D Extra Help, you will pay less in drug premiums and copayments or coinsurance. You also will be covered during the Coverage Gap (the “Donut Hole”), and you will not have to pay late enrollment penalties. For more information on the LIS Extra Help Program, click here.

Click Here for a 2018 summary of monthly plan premiums for those eligible for extra help.


Medicare beneficiaries may also enroll in Farm Bureau Essential Rx or Farm Bureau Select Rx through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Members Health Insurance Company/Farm Bureau Health Plans is a PDP plan with a Medicare contract. Enrollment in Members Health Insurance contract depends on contract renewal. Members Health Insurance Company/Farm Bureau Health Plans does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability or geographic location within the service area. All Members Health Insurance Company/Farm Bureau Health Plans items and services are available to all eligible beneficiaries in the service area.

Last Modified: 06/06/2018 at 4:20:56 PM
S2668_CMWSFL17093 Approved 11/3/17