Purpose:
** To optimize therapeutic outcomes for individual patients.
** Optimize drug therapies.
** Improve medication use.
** Reduce risk of adverse events and drug interactions.
** Increase patient adherence and compliance with prescription drugs.
** Identify interventions that provide improved care to members.
** Interventions should result in health benefits for the Members and cost
effective for the Members and CarePlus.
Medicare Required Criteria for MTM Eligibility:
** Beneficiary must have multiple chronic diseases.
** Beneficiary must have filled multiple covered Part D drugs.
** Beneficiary must be likely to incur annual cost of more than $3,000 all
covered Part D drugs.
CarePlus MTM Eligibility:
** Member must be diagnosed with 3 or more core chronic disease conditions.
** Members with 8 or more unique Part D Medications.
Examples of Core Chronic Conditions:
** Chronic Heart Failure
** Diabetics Mellitus
** Dyslipidemia
** Hypertension
CarePlus MTM Program Design:
The CarePlus MTM will notify the
beneficiary of the Comprehensive Medication
Review (CMR) opportunity through MTM messaging in the Smart SummaryRx
statements once determined eligible for the MTM
program. The phone number to the
Member Services call center will be
provided so the member can schedule their CMR.
MTM consultations will allow a beneficiary
to speak with a clinical advisor
(Pharmacist, Registered Nurse) about their CMR and / or any identified
drug related problems. The clinical advisor will then work
through the targeted interventions by consulting with beneficiaries and serving
as their advocates in contacting prescribers, as necessary, to resolve drug
therapy problems.
CarePlus will perform targeted medication
reviews at least quarterly to assess
medication use and determine if a follow up intervention is
warranted for the beneficiary and / or prescriber. CarePlus will reach out to
the beneficiary and / or prescriber via one of the following ways: Telephonic,
Face to face, Mail or Fax.
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