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Medication Therapy Management

 

The Highmark Medication Therapy Management (MTM) program is an integrated pharmacy experience that helps Medicare Advantage members with chronic conditions and high prescription costs better manage their medications.

 

We'll help you make a plan

We want to identify potential gaps in care as early as possible. That’s why we work with you to create a Medication Action Plan. This plan is a simple, easy-to-understand guide for you to discuss with your doctor about potential drug therapy problems associated with your particular condition, helpful recommendations, and important counseling information.

Making sure that you can afford the medications you need is an important part of the MTM program, too. We keep your personal budget in mind and give recommendations on cost savings opportunities wherever we find them.

 

Extra Highmark help managing your prescriptions

The MTM program provides an extra layer of support by assigning a pharmacist to work directly with you to help ensure that your prescriptions are safe and working to their best ability. Your pharmacist will provide:

A Comprehensive Medication Review (CMR) - Every year, either the member or a caregiver will meet with a pharmacist to go over prescriptions and identify drug therapy problems. At the end, you’ll receive a Personal Medication List and, if needed, letters of recommendation to help make sure your treatment is working how it should.

Targeted Medication Reviews (TMR) - Once per quarter, your provider will be updated on any new information or potential issues to keep you on the right track between CMRs.

Coordination services - We’ll work directly with your doctor, when needed, to help make sure everything goes smoothly.

 

The MTM program is free for qualified Medicare members. If eligible, you’ll be automatically enrolled and receive instructions in the mail about how to take advantage of the program’s great services.

 

Eligibility for the MTM program

This program is for Medicare members who suffer from at least three of the following conditions:

— Osteoporosis

— Rheumatoid arthritis

— Chronic obstructive pulmonary disease

— Chronic heart failure

— Diabetes

— High cholesterol

— Depression

 

In addition to having at least three of these conditions, you must also be prescribed at least seven chronic or maintenance Part D medications and are likely to incur annual costs of at least $4,255 for all covered Part D drugs.

 

Enrolling in the MTM program

If you meet the above eligibility requirements, then you’ll be enrolled in the MTM program automatically. If you do not want to participate in the program, then you can choose to opt out at any time.

 

Service documents

Take a look at the PDFs below if you’d like to see samples of the types of documents you will receive as a participant. These samples are intentionally left blank.

Personal Medication List

Medication Action Plan

 

Contact information

There are several ways to contact us if you have questions about MTM program eligibility or services:

   — Call the 1-800 number listed in your welcome letter.

   — Call 1-877-468-0072, Monday - Friday, 9:00 a.m. - 9:00 p.m. (ET).

   — Call the Member Service number listed on the back of your Highmark member card.