What is this program about?
Medication Therapy Management (MTM) ensures South Country Health Alliance members are using the right drugs to treat their medical conditions. The program helps reduce the risk for potential drug issues and helps members learn how to get the most from their medications. Pharmacists are available to answer questions about prescription medicines and over-the-counter products. The MTM program is available to all eligible members at no additional cost.
What can I expect?
- A review of your medicines
- Personalized medicine lists
- Help in understanding how your medicines work and their side effects
- Educational materials about your conditions and prescriptions
How do I start?
If you meet the eligibility criteria below, you will be automatically enrolled. (Note: The MTM program is voluntary. You may opt out at any time.) You may choose to only take part in the services you find most valuable. Your drug benefits will not change if you do or do not participate in all or part of the program.
Eligibility Criteria
You can participate in the MTM program if you meet all the following criteria:
- Have 3 or more of the following chronic conditions:
- Alzheimer's Disease
- Bone Disease-Arthritis (including osteoporosis, osteoarthritis and rheumatoid arthritis)
- Chronic Congestive Heart Failure (CHF)
- Diabetes
- Dyslipidemia
- End-Stage Renal Disease (ESRD)
- Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)
- Hypertension
- Mental-Health (including depression, schizophrenia, bipolar disorder and chronic/disabling mental health conditions)
- Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD) and chronic lung disorders)
- Take 5 or more medications in the following Part D-covered drug classes:
- ACE Inhibitors
- Angiotensin II Receptor Blockers (ARBs)
- Antidepressants
- Antihyperlipidemics
- Antihypertensives
- Antipsychotics
- Beta Blockers
- Bisphosphonates
- Bronchodilators
- Calcimimetics
- Calcium Channel Blockers
- Cardiac Glycosides
- Colony Stimulating Factors
- Disease Modifying Antirheumatic Drugs (DMARDs)
- Diuretics
- Inhaled Corticosteroids
- Insulins
- Neprilysin Inhibitors
- NSAIDs
- Oral Hypoglycemics
- Phosphate Binders
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Vitamin D Analogs
- GLP-1 Receptor Agonists
- Spend more than $1,623 in the previous quarter on your medications
How does it work?
You will receive an engagement packet that includes the following:
- Information about the MTM program
- An offer to schedule a comprehensive medication review
- A questionnaire that will ask about other medications you use (including over-the-counter or supplements) and any medication allergies you may have
- Information on how to dis-enroll from the MTM program
- A health education newsletter focused on one of your chronic conditions
If you choose to have a comprehensive medication review phone call:
- A pharmacist, registered nurse, licensed practical nurse or pharmacy intern under the direct supervision of a pharmacist will review your medications, history and any information collected from the engagement packet questionnaire. The pharmacist will then call you or your caregiver via phone or telehealth to conduct a medication review consultation.
- The pharmacist will look for drug therapy problems including medication adherence, therapeutic duplication, drug-drug interactions, drug-disease interactions, and appropriate dosing and polypharmacy.
- The pharmacist will write and mail a summary of consultation including a medication action plan and personal medication list and send it to you or your caregiver.
We will regularly review our claims data for all MTM participants to see if a targeted medication review is needed. Targeted medication reviews are performed by a pharmacist, registered nurse, licensed practical nurse or pharmacy intern under the direct supervision of a pharmacist for certain medication and chronic condition issues. If we find problems, we may contact your health care provider. You will also receive a medication guide specific to your chronic condition that explain when and how to take your medications, along with possible side effects to watch for.
You may be referred to the South Country Health Alliance care coordination team if additional assessment, facilitation, health care coordination, evaluation, and advocacy for options and services are identified.
We hope you will participate in our program.
Remember: There is no added cost for the MTM program, and you may leave the program at any time. This service is not considered a benefit.
South Country Health Alliance members: If you want more information about the MTM program or are interested in getting copies of service documents, call 1-888-349-0501 (TTY users call 1-888-765-6351) between 9:30 a.m. and 6 p.m. CST, Monday through Friday. If you are not a South Country Health Alliance member, call Member Services.