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Medication Therapy Management Program (MTMP)

Florida Blue/Florida Blue HMO/FHCP Medicare:

  • What is Medication Therapy Management?

    The Medication Therapy Management (MTM) program reviews the medicines you take to make sure that they’re safe, work well and fit your lifestyle. This program is offered at no additional cost to eligible members. This service is not considered a benefit.

    The goal is to help you get the best results from your medicines, at the lowest possible price. The MTM program is the right choice if you need answers to questions below

    • Why am I taking these medicines?
    • Do over-the-counter products interact with my prescriptions?
    • Can I save money on my prescriptions?

    The program can also help you and your doctor make sure that your medicines are the best choice for you.

  • Who's eligible for MTM?

    You're automatically enrolled in the MTM program if you meet the criteria listed below.

    2018

    Have three or more of the following conditions:

    • Chronic Heart Failure
    • Diabetes
    • High blood pressure
    • High blood cholesterol
    • Rheumatoid arthritis

    And

    Take eight or more prescription medicines covered by Medicare Part D.
     
    And


    Spent more than $3,967 in 2017 on prescription medicines covered by Medicare Part D.

    2019

    Have three or more of the following conditions:

    • Alzheimer’s Disease
    • Anemia
    • Atrial Fibrillation
    • Anticoagulation
    • Cardiovascular
    • Cerebrovascular Disease
    • Chronic Heart Failure
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Diabetes
    • End-Stage Renal Disease (ESRD)
    • High blood pressure
    • High blood cholesterol
    • Rheumatoid arthritis
    • Respiratory Disease- Chronic Lung Disorders

    AND

    Take eight or more prescription medications covered by Medicare Part D.

    AND

    Expect to spend more than $4.044 in 2019 on prescription medicines covered by Medicare Part D.
  • What Services Does The MTM Program Offer?
    • Yearly Comprehensive Medication Review (CMR)
    • Quarterly Targeted Medication Review (TMR)

    These services are provided by telephone, or, in some cases, in person.

  • What can you expect?

    The MTM program is a two-part program. Reviews may be done over the phone, whenever it’s convenient for you. In some cases, you may have an in-person review.

    1. For a Comprehensive Medication Review (CMR)

      This personalized review lets you talk one-on-one with an MTM pharmacist.

      To get ready for your review make a list of all the medicines you take. Write down even over-the-counter medicines or supplements. Include how much you take each day and how often you take them. The pharmacist will review your list and talk about it with you. This usually takes about 30 minutes.

      After your review, you’ll get a complete list of your medicines — a personal medication list and an action plan that you can bring with you to your next doctor’s visit.

    2. For a Targeted Medication Review (TMR)

      Every few months, the program reviews your prescription claims to make sure there are no issues that need attention. If the review identifies any issues, we may contact your doctor.

  • Getting Started

    If you’re eligible for MTM, you’re automatically enrolled. You’ll get a letter or phone call letting you know how to schedule an appointment or opt out of the program.

  • Opting out

    Medicare requires us to automatically enroll you if you’re eligible. But, this service is voluntary — you’re not required to participate. You may also choose to take part in only certain services you find valuable. You can change your enrollment status at any time during the calendar year. Your prescription drug coverage will not change if you take part in the MTM program or not.

  • For more information

    2019 MTM informational brochure

    If you'd like to know more, call the customer or member service phone number on the back of your member ID card. Ask to speak to someone about the MTM program.

    The MTM Program is a service offered to eligible members at no extra cost; this service is not considered a benefit.

Florida Blue/Florida Blue HMO want to ensure our members’ satisfaction. For additional information regarding Medication Therapy Management Programs (MTMP), you may call our Member Services number at 1-800-926-6565 (TTY: 1-800-955-8770). Florida Blue Medicare member, please call 1-855-601-9465 (TTY: 1-800-955-8770). Hours are 8 a.m. - 8 p.m. local time, seven days a week from October 1 to March 31, except for Thanksgiving and Christmas. From April 1 to September 30, we are open Monday - Friday, 8 a.m. - 8 p.m. local time, you will have to leave a message on Saturdays, Sundays and Federal holidays. We will return your call within one business day. TTY users can dial 1-800-955-8770.

Florida Blue Preferred HMO:

BlueMedicare Preferred HMO has a free voluntary program for members who have multiple medical conditions, take many prescription drugs, and have high drug costs. We utilize this program to help members manage medications and make sure our members are receiving medications according to their medical conditions, identify any possible medication interactions, duplication of therapy, and review drug dosages according to the appropriate prescribing standards.

  • Are you eligible for MTM?

    Please note that the Medication Therapy Management Program (MTMP) is not considered a benefit. It is available to you at no cost if you qualify. You will be automatically enrolled in this program if you meet all of the following three criteria:

    2018

    1. Have three or more chronic medical conditions, such as

    • Arthritis
    • Osteoporosis
    • Dyslipidemia
    • Diabetes
    • High blood pressure
    • High cholesterol

    2. Take eight or more Medicare Part D covered drugs.

    3. Expect to spend more than $3,967 in 2018 on covered Medicare Part D prescriptions.

    2019

    1. Have three or more chronic medical conditions, such as

    • Chronic Obstructive Pulmonary Disease (COPD)
    • Chronic Heart Failure (CHF)
    • Rheumatoid Arthritis
    • Alzheimer's Disease
    • Bipolar Disorder

    2. Take eight or more Medicare Part D covered drugs

    3. Expect to spend more than $4,044 in 2019 on covered Medicare Part D prescriptions.

The MTMP offers a comprehensive review of all your medications and discusses with you over the phone on how to better manage your conditions with drug therapy. If you are eligible for this program, you will be notified by mail. We will then contact you by telephone to perform this service. Each session takes about 30-40 minutes. After the telephone session, we will send you a Personal Medication List (PML) and Medication Action Plan (MAP) which are summaries of what we’ve talked about. We will also perform Targeted Medication Review quarterly and may contact you or your doctor directly if there are questions about your medications.

Florida Blue Preferred HMO Members may call our Member Services number at 1-844-783-5189 for additional information. (TTY users should call 1-800-955-8770.) Hours are 8:00 a.m. - 8:00 p.m. local time, seven days a week. TTY users can dial 1-800-955-8770.

Florida Blue Stand-Alone Prescription Drug Program:

  • What is Enhanced Medication Therapy Management?

    You may be eligible for the Enhanced Medication Therapy Management (Enhanced MTM) Program. Enhanced MTM is a program that is voluntary and free to members. The Enhanced MTM program replaces the standard Medication Therapy Management (MTM) program. Medicare created the Enhanced MTM program. The Enhanced MTM program offers new ways to improve your quality of care. Florida Blue stand-alone Prescription Drug Plan members in BlueMedicare Premier Rx (PDP) may be eligible for Enhanced MTM.

    Florida Blue Stand Alone Prescription members may call 1-800-926-6565, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week from October 1 - March 31, and closed Federal Holidays except for Thanksgiving and Christmas. From April 1 - September 30, we are open Monday - Friday 8 a.m. - 8 p.m. local time, except for Federal holidays. 

Florida Blue is a PPO, RPPO and Rx (PDP) Plan with a Medicare contract. Florida Blue HMO and Florida Blue Preferred HMO are HMO Plans with a Medicare contract. Enrollment in Florida Blue, Florida Blue HMO or Florida Blue Preferred HMO depends on contract renewal.

For assistance, current BlueMedicare Classic (HMO), BlueMedicare Classic Plus (HMO), BlueMedicare Premier (HMO), BlueMedicare Complete (HMO SNP), BlueMedicare Select (PPO), BlueMedicare Choice (Regional PPO), BlueMedicare Value (PPO), BlueMedicare Value Rx (PDP), BlueMedicare Premier Rx (PDP) and BlueMedicare Complete Rx (PDP) members should call our Member Services number at 1-800-926-6565 (TTY: 1-800-955-8770). Florida Blue Medicare member, please call 1-855-601-9465 (TTY: 1-800-955-8770). Hours are 8 a.m. - 8 p.m. local time, seven days a week from October 1 to March 31, except for Thanksgiving and Christmas. From April 1 to September 30, we are open Monday - Friday, 8 a.m. - 8 p.m. local time.

For assistance, current BlueMedicare Preferred (HMO), BlueMedicare Preferred HMO (HMO SNP) and BlueMedicare Preferred POS (HMO POS) Member Services number at 1-844-783-5189 for additional information. (TTY users should call 1-800-955-8770.) Hours are 8:00 a.m. - 8:00 p.m. local time, seven days a week.

Florida Blue Medicare Supplement Insurance policies are not connected with or endorsed by the U.S. Government or the Federal Medicare Program.These policies have limitations and exclusions.

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.
 

 

Last Updated: 10.01.2018

Y0011_34455 1018 CMS Accepted

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