Prescription Support Programs

The Medication Therapy Management (MTM) Program is a service for members with multiple health conditions who also take multiple medicines. The MTM program helps you and your doctor make sure that your medicines are working to improve your health.

Blue Advantage determines eligibility monthly by looking at your pharmacy and medical claims. Once you qualify, you are automatically enrolled in the program for the rest of the calendar year.

To qualify for the 2024 MTM program, you must meet all three of the following criteria:

• You have three of the following conditions:
• Congestive heart failure, diabetes, high cholesterol, high blood pressure, COPD, anemia, chronic noncancer pain,
  AND
• You are taking eight or more chronic/maintenance (covered Part D) classes of medications, AND
• You are likely to spend more than $5,330 in 2024 on prescription drug costs (includes amounts paid by both you and Blue Advantage) OR
• You are enrolled in a Drug Management Program that helps you better manage and safely use your medications such as those used for pain

If you qualify, you will receive a letter with information on scheduling a 20 – 30-minute phone call for a detailed medication review. During that call, a pharmacist or pharmacy intern will complete a comprehensive medication review of your medicines and talk with you about:

Any questions or concerns about your prescription or over-the-counter medicines, such as drug safety and cost

Better understanding your medicines and how to take them

How to get the most benefit from your medicines

A summary will be mailed to you that includes a medication action plan with space for you to take notes or write down any follow-up questions. You will also receive a personal medication list of all the medicines you take and why you take them.

At least once every 3 months, your medications will be reviewed, and you or your doctor will be contacted about any possible changes in your medicines.