Medication Therapy Management Program

For our Classic (HMO-POS), Rewards (HMO), and Value (HMO) members

As a Medicare member, you may take medications prescribed by more than one doctor, or have several different prescriptions. Your wellness and health are our priority, so we want to make sure any issues such as:

  • Reduced effectiveness
  • Severe side effects
  • Greater expense than necessary

We offer a Medication Therapy Management (MTM) Program at no additional cost to ensure your medications are working together to improve your health. MTM services are not considered a benefit.

Our MTM program is designed to assist Medicare members who have multiple medical conditions, are filling at least eight prescription drugs per month, and/or have high drug costs.

To qualify for this assistance, you must accumulate drug costs exceeding a certain amount in one quarter and have at least three of the following chronic conditions: Bone Disease-Arthritis-Osteoporosis, Chronic Heart Failure (CHF), Diabetes, End-Stage Renal Disease (ESRD), Respiratory Disease-Chronic Obstructive Pulmonary Disease (COPD).

If you meet this criteria, you are automatically enrolled in our MTM program. We'll mail you an enrollment form to confirm your participation. Should you wish to decline, simply sign the opt-out section at the bottom of the enrollment form and mail it back. 

What We Include in the MTM Program

Targeted Medication Reviews: Assessments that focus on key drug therapy problems and/or medication safety concerns. You or your healthcare provider may be contacted as a result of a Targeted Medication Review. This type of review lasts approximately 10 minutes and can be conducted by phone or in person.

Comprehensive Medication Reviews: A 30-minute consultation by phone or in person with a pharmacist or other qualified health professional, who will review all of your medications and talk with you about:

  • Why each medication is prescribed
  • Whether any medications are potentially unnecessary
  • How well your medications are working
  • Whether your medications have side effects
  • If there might be drug interactions between the drugs you’re taking
  • Whether your costs can be lowered
  • If another medication could benefit your health
  • If there are issues that prevent you from taking your medication, such as transportation to the pharmacy, side effects or costs

After your Comprehensive Medication Review, you will receive:

A Medication Action Plan: This will include steps you should take to get the best results from your medications.

For more information about the Health First Health Plans MTM program, please contact your Customer Service Representative.

Health First Health Plans is an HMO plan with a Medicare Contract. Enrollment in Health First Health Plans depends on contract renewal.

 

Y0089_EL108008_M | Accepted date: 10/01/2023
Last updated: 10/01/2023