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Members enrolled in Blue Medicare HMO℠ or Blue Medicare PPO℠ with Medicare prescription drug benefits or Blue Medicare Rx℠ may be eligible for the Medication Therapy Management Program (MTM), in accordance with CMS requirements. The MTM Program helps members understand their medications better.
Medication therapy management program
1. Individual members eligible for the MTM Program services must meet all 3 criteria below:
- Have at least 3 of the following chronic conditions: diabetes, chronic obstructive pulmonary disease (COPD), high blood cholesterol, chronic heart failure (CHF), or rheumatoid arthritis
- Take at least 8 or more prescription medications covered by Part D
- Expect to spend more than $5,330 in 2024 on prescription medicines covered by Medicare Part D
and / or
2. Have an active coverage limitation for an opioid or frequently abused medicine as a result of a Drug Management Program.
The MTM Program services include the following interventions for members and prescribers:
- An annual comprehensive medication review (CMR) with a pharmacist to go over prescription and non-prescription medications that you take.
- Quarterly Targeted Medication Reviews which look for any safety or other issues which may need attention. The member’s prescriber may be contacted if any issues are found.
A Comprehensive Medication Review (CMR) is a person-to-person review of your medications with a pharmacist or nurse. The appointment usually takes about 30 minutes. During that time the pharmacist will:
- Review the medicines you take
- Create a personal medicine list
- Help you understand how your medicines work
- Tell you about side effects from your medicines
- Answer any questions or concerns you have
- If you are eligible, you will be automatically enrolled in the program. Eligible members will receive a letter inviting them to schedule a medication review with a pharmacist.
- You may return the participation form in the mail or call a toll-free phone number (866-686-2223 or TTY users call 711) between 10 AM and 6 PM Eastern Time, Monday through Friday (except major holidays).
- Participation in the program is voluntary.
Members may opt out from participating in the program.
This can be done by calling the telephone number listed in the notification letter (866-484-3953 or TTY users call 711) 24 hours a day, 7 days a week.
When prompted, enter your opt-out personal security PIN. You may refuse individual services without having to opt out from the whole program.
- Educate members regarding their medications
- Increase understanding about how to take medications as prescribed
- Identify and prevent medical complications related to medication therapy
Members should refer to their Evidence of Coverage for more details on the MTM program. This program is not considered a benefit and is offered at no cost to eligible members.
Disclosures:
Blue Cross and Blue Shield of North Carolina is an HMO, HMO-POS, PPO and PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal.
Blue Cross and Blue Shield of North Carolina Senior Health DBA Blue Cross and Blue Shield of North Carolina is an HMO-POS D-SNP plan with a Medicare contract and a NC State Medicaid Agency Contract (SMAC). Enrollment in Blue Cross and Blue Shield of North Carolina Senior Health depends upon contract renewal.
Blue Medicare Supplement plans offered: [Plan A: BMS A, 1/24, Plan G: BMS G, 1/24, Plan HI DED G: BMS HDG, 1/24, Plan K: BMS K, 1/24, Plan N: BMS N, 1/24.]
Blue Medicare Supplement is not endorsed by or affiliated with the United States Government or the federal Medicare program.
Blue Cross and Blue Shield of North Carolina does not discriminate based on race, ethnicity, national origin, religion, gender, age, mental or physical disability, health status, claims experience, medical history, genetic information, evidence of insurability, sexual orientation or source of payment. All Blue Cross and Blue Shield of North Carolina items and services are available to all eligible beneficiaries in the service area.
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Current as of 07/12/2024 | Y0079_12318_M CMS Accepted 08282024 | U36079, 6/24
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