2016 Medication Therapy Management Program

Clover partners with our friends at Mirixa to offer the Medication Therapy Management (MTM) program, which helps you get the greatest health benefits from your medications by:

  • Preventing or reducing drug-related risks
  • Increasing your awareness
  • Supporting good habits

 

Who qualifies for the MTM program?

We'll automatically enroll you in the Medication Therapy Management program at no cost if all three of these conditions apply to you:

  1. You take eight or more Medicare Part D-covered maintenance drugs
  2. You have three or more of these long-term health conditions:
    • Asthma
    • COPD
    • Diabetes
    • Depression
    • Osteoporosis
    • Chronic heart failure
    • HIV
    • Cardiovascular disorders such as high blood pressure, high cholesterol, or coronary artery disease
  3. Your yearly medication costs split between both you and the plan equal at least $3,507

Your participation in the MTM program is voluntary and doesn't affect your coverage. Only available to those who qualify, this program is offered free-of-charge but isn't considered a benefit for all members.

 

What services are included in the MTM program?

The MTM program provides a:

  • Comprehensive Medication Review (CMR)
  • Targeted Medication Review (TMR)

 

What's a Comprehensive Medication Review (CMR)?

A CMR is a one-on-one discussion with a pharmacist to answer any questions you have about the medications you take, which may include:

  • Prescription drugs
  • Over-the-counter (OTC) medicines
  • Herbal therapies
  • Dietary supplements and vitamins

The pharmacist will help you understand ways for managing your conditions with the drugs you’re currently taking. If more information is needed, the pharmacist can contact your prescribing doctor. A CMR review takes about 30 minutes and is usually offered once per year. At the end of your discussion, the pharmacist will give you a Personal Medication List of the prescriptions you discussed during your CMR.

You'll also receive a Medication Action Plan, which may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

If you'd like, you can also track your prescriptions in a Personal Medication List ( English | Español ).

 

What's a Targeted Medication Review (TMR)?

We preform a TMR every three months by mailing or faxing prescription drug suggestions to your doctor that may be safer or work better than your current medications. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs won't change unless you and your doctor decide to change them.

 

How will I know if I qualify for the MTM program?

If you qualify, we'll reach out to you proactively with a letter in the mail letting you know. Afterward, you may receive a call from a partner pharmacy inviting you to schedule a one-on-one medication review. This review can take place either by phone or in person.

 

Will the program's pharmacist be calling from my regular pharmacy?

Yes, so long as your regular pharmacy agrees to participate in the MTM program. If they do, you'll be given the option to choose either an in-person or phone review.

If your regular pharmacy doesn't participate in the program, you may be contacted by a call center pharmacist to provide your MTM review. All call center reviews are conducted by phone.

 

How do I benefit from pharmacist reviews?

Different doctors may write prescriptions for you without knowing all the medications and/or OTC drugs you're currently taking. For that reason, a pharmacist will:

  • Discuss how your prescription and OTC medications may affect one another, giving you the peace-of-mind of knowing you’re taking all your medications safely
  • Identify any prescription drugs and OTC medications that may cause side effects, offering suggestions that can reduce these complications
  • Review opportunities for helping you reduce prescription drug costs
  • Help you organize a Personal Medication List you can share with doctors to help strengthen your overall healthcare experience

 

How can I get more information about the MTM program, and what if I don't want to participate at all?

For more information about the MTM program, or if you don't want to participate at all, call us toll-free at 1-888-657-1207, (TTY 711), 8am – 8pm EST, 7 days a week.*