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Medication Therapy Management Program

Great Plains Medicare Advantage (HMO I-SNP)
Great Plains Medicare Advantage Gold (HMO I-SNP)

What you should do if you wish to join the medication therapy management program

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Great Plains Medicare Advantage at no additional cost to you. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.

To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.

To qualify for the MTM program, you must meet ALL of the following criteria:

1. Have at least 3 of the following conditions or diseases:

      • Alzheimer’s Disease
      • Chronic Heart Failure (CHF)
      • Diabetes
      • Dyslipidemia
      • Hypertension
      • Mental Health-Depression
      • Respiratory Disease-Asthma
      • Respiratory Disease-Chronic
      • Obstructive Pulmonary disease (COPD)
      • HIV

2. Take at least 8 covered Part D medications, AND

3. Are likely to have medication costs of covered Part D medications greater than the annual cost threshold as defined by CMS.

This review, or CMR, is provided to you confidentially via telephone.

OR

4. Are 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 more 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, and 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 health care provider.

Comprehensive Medication Review (CMR)

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 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.

Do you have unused expired medications and are looking for a safe way to dispose of them? Before you throw them away, here are some things you should know.

Here is how to safely dispose of unused or expired medications before they do harm:
For safety reasons, dispose of unused medications as soon as possible. Here are a few tips for safe disposal:

    • Find a nearby pharmacy or other local resource with a medication take back service.
    • If you cannot get to a drug take back location promptly, or there is none near you:
        • Mix the unused supply with an undesirable substance such as dirt or coffee grounds.
        • Put the mixture into a disposable container with a lid, such as an empty margarine tub, or into a sealable bag, then place the sealed container in your trash.
        • Make sure to conceal or remove any personal information, including Rx number, on the empty containers by covering it with black permanent marker or duct tape, or by scratching it off to protect your privacy.
        • Place both the sealed container with the mixture and the empty drug containers in the trash.
        • Only flush approved unused or expired medications down the toilet only if indicated on the label, patient information, or no other disposal options are available.

More information on the safe disposal of medications can be found on the United States Department of Health and Human Services website:

https://www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html

Contact OptumRx or your health plan at the number listed on the back of your ID card for more information about our MTMP. If you have any questions about the MTM program, please call the MTM Department at 1-866-352-5305. (TTY users dial 711), Monday – Friday, 8 am to 8 pm CST.

These programs are provided at no additional cost as part of your coverage and are not considered a benefit.

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