Pharmacy Benefits

A drug recall is when a medication or an over-the-counter product is removed from the market. A drug can be voluntarily recalled by the drug company and the FDA, or the FDA can require a recall. The FDA makes sure that recalls are handled correctly to safely stop the drug from being sold.

A drug may be recalled for many reasons, like safety concerns, mislabeling, or because it was poorly produced by the company.

To qualify for MTMP, a member must meet all of the following criteria:

• Members must have filled eight or more chronic Part D medications; and
• Members must have at least three of the following ten chronic conditions
  • High blood pressure
  • High cholesterol
  • Congestive heart failure (CHF)
  • Diabetes
  • Depression
  • Osteoporosis
  • Rheumatoid arthritis
  • Asthma
  • COPD
  • HIV
• Members must be likely to incur annual costs of $4,935 or more for all covered chronic Part D medications.

OR

• Members must be in a drug management program to help better manage and safely use medications such as opioids and benzodiazepines

Do you meet all of the criteria above? Learn more¹ about how to manage the various medications you need to stay healthy.

The success of our MTMP is built upon our proven experience using a wide range of services designed to help members with multiple conditions by:

• Ensuring they take their medications correctly
• Improving medication adherence
• Detecting potentially harmful medication uses or combinations of medications
• Educating members and health care providers

Our programs are evidence-based and can integrate both pharmacy and medical data, when available. They are built upon multiple measures that demonstrate positive clinical outcomes for members like you. Pharmacists, physicians, and PhDs develop, manage, and evaluate the programs for effectiveness.

One-on-one consultations between our clinicians and members are also an important part of our MTMP. Such consultations ensure that members are taking their medications as prescribed by their healthcare provider.

The Centers for Medicare & Medicaid Services (CMS) requires all Part D sponsors to offer an interactive, person-to-person comprehensive medication review (CMR) to all MTM-eligible members as part of an MTMP. If you meet the criteria outlined above, you will receive an MTMP Enrollment Mailer or phone call offering our CMR services.

A CMR is a review of a member’s medications (including prescription, over-the-counter (OTC), herbal therapies, and dietary supplements), which is intended to aid in assessing medication therapy as well as optimizing outcomes. Also, MTMP-eligible members will be included in quarterly targeted medication review (TMR) programs that assess medication profiles for duplicate therapy or drug-disease interaction in which members’ prescribers may receive a member-specific report.

The CMR includes three components:

1. Review of medications to assess medication use and identify medication-related problems. This may be conducted person-to-person or “behind the scenes” by a qualified provider and/or using computerized, clinical algorithms
2. An interactive, person-to-person consultation performed by a qualified provider at least annually to all MTM-eligible members
3. An individualized, written summary of the consultation for the member, including but not limited to a medication list, reconciled medication list, and recommended to-do list for monitoring, education, or self-management

View or download a sample copy of our MTMP Enrollment Mailer

View or download a copy of the Recommended To-Do List

View or download a copy of the Medication List