Medication Therapy Management(MTM) for Plan Year 2024

What is the Central Health Medicare Plan MTM program?

The Central Health Medicare Plan MTM program helps you get the greatest health benefit from your medications by:

• Ensuring all of your medications work well together
• Providing education about important side effects to look out for
• Allowing you to ask questions about over-the-counter (OTC) medications, herbal remedies, and vitamins
• Learn the best time to take your medications and get help remembering to take them as prescribed

Who qualifies for the program?

We will automatically enroll you in the Central Health Medicare Plan MTM program at no cost to you if you meet the conditions of at least one of the following two groups (1) or (2):

Group 1.

1. You take eight or more Medicare Part D covered maintenance medications, AND
2. You have three or more of these long-term health conditions:
   • Asthma
   • Benign Prostatic Hyperplasia (BPH)
   • Diabetes
   • Dyslipidemia
   • Hypertension
   • Rheumatoid Arthritis (RA)
3. You reach $5,330 in yearly prescription drug costs paid by you and the plan, OR

2. You are eligible for the Drug Management Program based on the Centers for Medicare and Medicaid Services (CMS) guidelines. Your participation is voluntary and does not affect your coverage. This program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all members.

What services are included in the program?

The program provides you with a:

• Comprehensive medication review (CMR), and
• Targeted medication review if follow up is needed

Comprehensive Medication Review

• 15-20 minute virtual visit with a MTM Pharmacist
• The MTM Pharmacist will review of all your medications (including prescription, over-the-counter (OTC) medications, herbal therapies, and dietary supplements) and medical conditions to determine if there are any medication therapy-related opportunities
• If needed, the MTM Pharmacist will work with your provider to resolve any opportunities identified as part of the review
• Within 14 days following the CMR, the MTM Pharmacist will mail out a Personal Medication List summarizing the medications you take and a Medication Action Plan if any concerns were identified. Information may also be mailed to your provider, based upon opportunities for medication therapy improvement.

The MTM Pharmacist will offer ways to manage your conditions with the medications you take. If more information is needed, the MTM Pharmacist may contact your prescribing provider. The review takes about 15-20 minutes and is usually offered once each year — if you qualify. At the end of your discussion, the MTM Pharmacist will provide you a Personal Medication List with the medications you discussed during your review.

You will also receive a Medication Action Plan. Your plan may include suggestions from the MTM Pharmacist for you and your provider to discuss during your next visit.

Here is an example of the Personal Medication List that you’ll walk through as a part of the program.

Targeted Medication Review

Upon qualifying for enrollment in the program, Central Health Medicare Plan may identify opportunities for a "Targeted Review" of your medications. As a result, Central Health Medicare Plan may contact your prescriber directly with suggestions about medications that may be safer or a better alternative to the current therapy. As always, medications won’t change unless your prescriber reviews and decides to change them.

How will I know if I qualify for the program?

If you qualify, we will mail you a letter. You may also receive a call, inviting you to participate in this one-on-one medication review.

Who will contact me about the review?

You may be contacted by a MTM Pharmacist to provide your review and ensure that you have access to the service if you want to participate. These reviews are most often conducted by phone. Your local pharmacist may also partner with your health plan to offer the service in-person.

Why is a review with a MTM Pharmacist important?

Different prescribers may write prescriptions for you without knowing all the prescription, and/or OTC medications you take. For that reason, a MTM Pharmacist will:

• Discuss how your prescription, and/or OTC medications may affect each other
• Identify any prescription, and/or OTC medications that may cause side effects and offer suggestions to help
• Help you get the most benefit from all your prescription, and/or OTC medications
• Review opportunities to help you reduce your prescription medication costs

How do I benefit from talking with a MTM Pharmacist?

• The MTM Pharmacist will make sure you are taking your prescription and OTC medications safely
• The MTM Pharmacist can look for ways to help you save money on your out-of-pocket prescription medication costs
• You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with all of your healthcare providers

How can I get more information about the program?

If you would like additional information about our program, or if you do not want to participate after being enrolled, please call The Member Services Department at 1-866-993-6058, TTY 711, Monday - Friday 8 am - 8 pm.