Medication Therapy Management

You will be enrolled in the Premera Blue Cross MTM program if you meet one of the following:

1.  Have coverage limitation(s) in place for medication(s) with a high risk for dependence and/or abuse, or
2. Meet the following criteria:
   1. You have three or more of these conditions:
      1. Chronic heart failure
      2. Diabetes 
      3. Dyslipidemia
      4. Hypertension
      5. Chronic alcohol and drug dependence
      6. End-stage renal disease (ESRD)
   2. You take eight or more maintenance medications covered by your plan
   3. You are likely to spend more than $5,330 in prescription drug costs in 2024

Your participation in the MTM program is voluntary and does not affect your coverage. This is not a plan benefit and is open only to those who qualify. There is no extra cost for the MTM program.

If you qualify, we will mail you a letter. You may also receive a call to set up your one-on-one medication review.

The comprehensive medication review is completed with a healthcare provider in person or over the phone. This review is a discussion that includes all your medications:

• Prescriptions
• Over the counter (OTC)
• Herbal therapies
• Dietary supplements

This review takes about 20 minutes or less to complete. During the review, you may ask any questions about your medications or health conditions. The healthcare provider may offer ways to help you manage our health and get the most out of your medications. If more information is needed, the healthcare provider may contact your prescriber.

At the end of the review, the healthcare provider will provide you with a summary of what you discussed. The summary will include the following:

• Medication action plan. Your plan may include suggestions for you and your prescriber to discuss during your next visit.
• Personal medication list. This is a list of all the medications discussed during your review. You can keep this list and share it with your prescribers and/or caregivers.
  • Here is a blank copy of the Personal Medication List (.pdf) for tracking your medications.

You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You can choose to complete the review in person or over the phone.

A healthcare provider may also call you to complete your review over the phone. When they call, you can schedule your review at a time that is best for you.

Trusted MTM Program partners: You may receive a call from the CVS Caremark Pharmacist Review Team or the Outcomes Patient Engagement Team to complete this service.

Different prescribers may write prescriptions for you without knowing all the medications you take. For that reason, the MTM program healthcare provider will:

• Review all your medications
• Discuss how your medications may affect each other
• Identify side effects from your medications
• Help you reduce your prescription drug costs

By completing the medication review with a healthcare provider, you will:

• Understand how to safely take your medications
• Get answers to any questions you may have about your medications or health conditions
• Review ways to help you save money on your drug costs
• Receive a personal medication list and medication action plan to keep and share with your prescribers and/or caregivers

The targeted medication review is completed by a healthcare provider who reviews your medications at least once every three months. With this review, we mail, fax, or call your prescriber with suggestions about prescription drugs that may be safer or work better for you. As always, your prescriber will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your prescriber decide to change them. We may also contact you by mail or phone with suggestions about your medications.