ᎠᏓᏅᏍᏙᏗ ᎠᎩᏍᏗ ᎤᏴᏍᏗ ᎠᏍᏓᏩᏛᏍᏗ ᏗᎯᏓ

Our plan has programs that help you manage your Part D medications in special situations. For example, 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 developed a program to help members like you with your healthcare. This is called the Medication Therapy Management Program, or MTMP. Our MTMP pharmacists help you and your doctor choose the drugs that work best to treat your medical conditions. They also help you get the greatest health benefit from your medications by:

• Preventing or reducing drug-related risks (and errors)
• ᎧᏁᏉᏤᎩ ᏣᏤᎵ ᎠᏂᎦᏔᎲᎩ
• ᏕᎦᎫᏍᏛᏍᎬ ᎣᏍᏓ ᏧᏂᎳᏅᏔᏅ ᎢᏳᎾᏛᏁᎵᏓᏍᏗ

The program is not a benefit. It’s an extra service that is voluntary and at no cost to eligible members who:

• Have three or more of these medical conditions:
• Alzheimer’s Disease
• Bone Disease – Osteoporosis, Osteoarthritis, Rheumatoid Arthritis
• Chronic Heart Failure
• ᎧᎳᏎᏥ
• Dyslipidemia – High Cholesterol
• End-Stage Renal Disease
• Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome – HIV/AIDS
• Hypertension
• Mental Health – Depression, Schizophrenia, Bipolar Disorder, and other chronic/disabling mental health conditions
• Respiratory Disease – Asthma, Chronic Obstructive Pulmonary Disease 
• Take eight or more chronic or maintenance Part D drugs
• Spend more than $1,623 each year on drugs

If you meet the above criteria, we enroll you in our program automatically. From there, one of our MTMP pharmacists reviews your medication history and sends you a welcome letter. The letter describes any potential medication related problems found and invites you to call for a full review. We may also reach out to you in other ways about your medications. If you do not want us to contact you, just tell us. We will remove you from the program.

The goal is to help you reach the best results to fit your needs. 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:

• Annual Comprehensive Medication Review (CMR). Conducted by phone or face-to-face, a CMR creates a collection of all of your medication-related information. The pharmacist will go over your medications and medical conditions and may contact your prescribing doctor. The CMR takes approximately 30 minutes, is usually offered once each year—if you qualify, and addresses concerns you may have about the medications you take, including:
• ᎠᏓᏅᏍᏙᏗ ᏗᎩᏍᏗ ᏧᏴᏍᏗ
• ᎢᏴᏛ-ᎾᏍᎩ-ᏗᏎᎯᎯ (OTC) ᏑᏓᎴᎩ ᏅᏬᏘ
• ᏧᏓᎴᏅᏓ ᎢᎾᎨᎮᎯ ᏅᏬᏘ ᏗᏓᏅᏬᏗᎢ
• ᎠᎵᏍᏓᏴᏗ ᏗᏑᏯᎾᎢ ᏧᎾᎵᏍᏕᎸᏙᏗ ᎠᎴ ᏗᎵᏍᏓᏴᏗ ᏧᎵᏑᏱ ᏗᎩᏍᏗ
• Written Summary. Within 14 days of the CMR, you’ll receive a standardized post CMR takeaway letter which includes a “Recommended To-Do List “ detailing the conversation with the MTM provider, a Personal Medication List (PML) (Sample PML- PDF), and may contain medication safe disposal information.

• Quarterly Targeted Medication Reviews (TMR). TMRs identify potential concerns. Our MTMP pharmacists will mail, fax or call you and your doctor with suggestions about drug therapies that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them.

A review with a pharmacist is important. Different doctors may write prescriptions for you without knowing all the prescriptions and/or OTC medications you take. For this reason, a pharmacist will:

• Discuss how your prescription and /or OTC medications may affect each other.
• Explain how your prescription and/or OTC medications may cause side effects and offer suggestions.
• Help you get the most benefit from all of your prescription and/or OTC medications.
• Review opportunities to help reduce your prescription drug costs.

Reviewing your medications with a pharmacist can result in real peace of mind and the knowledge you need to take medications safely. If you want to participate in our MTMP but need assistance, you can authorize someone on your behalf. Your MTMP pharmacist can work with other authorized team members to help you reach your health goals. 

If you would like to talk with a pharmacist about your medications, or if you do not want to participate after being enrolled into the program, please call Express Scripts toll-free at 1-855-931-2782 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. Central Standard Time (CST).

Qualified members may receive a call from The Healthy Living Program, MedWatchers, or a local Pharmacist.