Have you ever felt uncomfortable about the ability of your Medicare patients to follow your instructions about medications?

BCBS (IL, NM, OK, and TX) has designed and implemented a program that focuses on assisting members with complex medication regimens as part of our Medicare Part D services.  It’s called the Medication Therapy Management Program (MTMP).

This program provides select high risk patients with a personal touch. Member support is provided at three levels utilizing call specialists, nurses, and pharmacists. The three levels include:

• Centralized telephone communication. Calls are made by specially trained call specialists, nurses and pharmacists with expertise in geriatrics. When appropriate, our clinical pharmacists communicate directly with the prescriber(s) to resolve important patient care issues. Educational materials are also provided in an effort to reinforce important medical and pharmacy concepts, assist in improving organizational skills and to promote improved communication with providers regarding medication issues.
• MTMP Coverage at the Network Pharmacy Level. In those instances when a network pharmacist has discovered a severe drug-drug interaction or other significant medication safety issue, the pharmacist will help to resolve these issues by communicating directly with the member and prescriber (s).
• Written communication for Medicare beneficiaries at Long Term Care (LTC) facilities. Information regarding specific medication issues (e.g. potential adverse drug events, over/under utilization, medications contraindicated in the elderly, etc.) in the geriatric population at LTC facilities is also provided to providers as needed.

What are MTMP’s goals?
The program is designed to achieve one or more of the following goals:

• Enhance member understanding through education and motivational counseling that promotes the appropriate use of medications and reduces the risk of potentially adverse events associated with the use of medications.
• Increase member adherence to prescription medication regimens.
• Detect potential adverse drug events and patterns of over-use and under-use of prescription drugs.

Describe quality outcome results that support MTMP services?
Our program has been evaluated by various Quality Improvement Organizations (e.g. Stratis Health of MN) for its effectiveness and member satisfaction.  Results for MTMP members are significantly higher than non-participating members in the area of treatment outcomes (e.g. ACEI/ARB for heart failure) and member satisfaction.

Is there a cost for a member to participate in the MTMP?
There is absolutely no additional cost to the member to participate in the MTMP.  All eligible members are invited to enroll in the program. Those members not wishing to participate have the option to decline of our services. By utilizing an opt-in service model we have been able to tailor our service based on individual member needs.

Can I refer a patient to your program?
Yes, we are glad to take your referrals; however, we can only provide services to those Medicare beneficiaries who meet the following CMS directed MTMP Qualification Criteria:

• Multiple chronic diseases (3 out of the following): asthma/COPD, diabetes, hyperlipidemia, osteoarthritis, depression, heart failure (CHF), hypertension, osteoporosis
• Multiple Part D drugs: > 6 medications to treat chronic conditions noted above
• Drug spend threshold: member must have greater than $1,000.00 per quarter or $4,000.00 per year in anticipated spending on Part D medications

MTMP (Prime Therapeutics) Contact information:

What can I do to get involved?
We mail out introduction letters to all qualified members and ask them to discuss their participation in the MTMP with their physicians.  Please encourage your patients to join.  We hope that you find that MTMP supports and supplements your efforts to provide quality healthcare in the Medicare population. Thank-you for your support!