Medication Therapy Management Program
Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) has programs to help members with their Part D medications in special situations. Some members have several complex medical conditions at one time. These members may need to take many drugs at the same time. These members also could have high drug costs. A team of pharmacists and doctors created a program for us to help these members with their care. The program is called the Medication Therapy Management program, or MTMP.
The MTMP helps make sure our members are using the drugs that work best to treat their conditions. The MTMP helps us find possible medication errors. The MTMP helps our members have better drug adherence. The program is not a benefit. There is no cost for members who qualify.
There is no pressure from the plan to join.
Members who are eligible for the MTMP have:
- Three or more of the following chronic disease states:
- Chronic Obstructive Pulmonary Disease (COPD)
- hypertension or high blood pressure
- dyslipidemia or high cholesterol
- end stage renal disease (ESRD)
- mental health-depression
- Eight or more chronic or maintenance Part D medications
- High drug costs (more than $3,967 each year).
If you meet the requirements for the MTMP, we will enroll you in the program. An MTM pharmacist will review your medication history and we will send you a letter telling you that you have qualified for MTMP. We will also inform you of any issues that were identified by the pharmacist. The letter will tell you to expect a call to schedule your drug review. You can also call and ask for a drug review.
If you do not want to be in the program, tell us. We will withdraw your name from the program.
The pharmacist or pharmacy intern under the direct supervision of a pharmacist will provide the following MTMP services with a final goal of helping the member reach the best therapeutic results to fit their needs:
- An annual Comprehensive Medication Review (CMR) is conducted either by phone or a face-to-face meeting to provide a collection of all the member’s medication related information and address any medication concerns. The CMR will take approximately 45 minutes.
- A Personal Medication List (PML) to record all prescription and over-the-counter medications which can be updated as needed (sample PML - PDF)
- A Medication Action Plan (MAP) made for the member after counseling to help them follow steps while taking medications to reach their health goals
- The PML and MAP are printed and either hand delivered or mailed within 14 calendar days of the Comprehensive Medication Review
- Quarterly Targeted Medication Reviews (TMR) will find possible safety concerns. Some drugs are not advised for those over age 65. The review may offer other drug therapies that may help the member. The member may be asked to talk with their doctor. A letter may be sent to the doctor.
A family member or friend can take part in the MTMP program for the member. The authorized representative form must be completed by the member for this person.
If you have questions about this program, or need assistance, please call the Member Services department at 1-866-896-1844. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned within the next business day. TTY users call 711. Member Services is prepared to answer questions about the MTMP.
Last Updated: 04/19/2018
Our plan has programs that help you manage your Part D medications in special situations. You may have several complex medical conditions. If so, you may need to take many prescription drugs to treat those conditions. You also could have high drug costs.
A team of pharmacists and doctors created a program to help members like you with your healthcare. This is called the Medication Therapy Management Program, or MTMP. Our MTMP pharmacists help our members and their doctors choose the drugs that work best to treat their conditions. They also help find possible errors and improve drug adherence.
The program is not a benefit. The service is voluntary and at no cost to eligible members who:
- Have three or more of these conditions:
- Chronic Obstructive Pulmonary Disease (COPD)
- End-Stage Renal Disease (ESRD)
- High cholesterol (hyperlipidemia)
- Take eight or more chronic or maintenance Part D medications
- Spend more than $4,044 each year on drugs
If you meet the above list, we enroll you in our program. From there, one of our MTMP pharmacists reviews your drug history and sends you a welcome letter. The letter tells you about any potential drug problems found and invites you to call for a full review. If you don’t want to continue, just tell us. We will remove you from the program.
If you want to continue, one of our pharmacists or pharmacy interns, under the direct supervision of a pharmacist, will connect you with the following services. The goal is to help you reach the best results to fit your needs:
- Annual Comprehensive Medication Review (CMR). Done by phone or face-to-face, a CMR creates a collection of all of your medication-related information. The pharmacist will go over your drugs and health conditions. The CMR takes about 45 minutes. You can talk about any of your concerns.
- Personal Medication List (PML). A list of all your prescriptions and over-the-counter drugs will be reviewed. The PML can be updated as needed. Sample PML (PDF)
- Medication Action Plan (MAP). Our MTMP pharmacist creates your MAP. It helps you follow steps in taking medications to reach your health goals.
- We print your PML and MAP and either mail or hand-deliver them to you within 14 days of your CMR.
- Quarterly Targeted Medication Reviews (TMR). This review helps find possible safety concerns. They include drugs that people over age 65 should not take. The TMR also may offer other drug therapies that you should be on for your conditions but aren’t. If our MTMP pharmacists find issues, we send you a letter with ways to help improve your drug use. We may also fax any issues to your doctor.
If you want to be in our MTMP but are unable to, you can authorize someone on your behalf. Our MTMP pharmacist may work with other team members if you need more help or services.
If you have questions about the MTMP, contact Member Services. We are here to help.
Last updated: 01/02/2019