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Medication Therapy Management (MTM) program

  • What is the Medication Therapy Management program?

    The Premera Blue Cross medication therapy management program helps you get the greatest health benefit from your medications by:

    • Preventing or reducing drug-related risks
    • Increasing your awareness 
    • Supporting good habits 

    Your participation is voluntary, and does not affect your coverage. The program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all plan members.

  • Am I eligible for the MTM program?
    2020

    We will automatically enroll you in the 2020 Premera Blue Cross program at no cost to you if all three conditions apply:

    • You take eight or more Medicare Part D covered maintenance drugs, and
    • You have three or more of these long-term health conditions:
      • Asthma
      • Chronic obstructive pulmonary disease
      • Diabetes
      • Depression
      • Arthritis
      • Osteoporosis
      • Chronic heart failure
      • Cardiovascular disorders such as high blood pressure, high cholesterol or coronary artery disease, and
    • You reach $4,255 in yearly prescription drug costs paid by you and the plan.

    Your participation is voluntary, and does not affect your coverage. The program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all plan members.

    2019

    We will automatically enroll you in the 2019 Premera Blue Cross MTM program at no cost to you if all three conditions apply:

    • You take eight or more Medicare Part D covered maintenance drugs, and
    • You have three or more of these long-term health conditions:
      • Asthma
      • Chronic obstructive pulmonary disease
      • Diabetes
      • Depression
      • Osteoporosis
      • Chronic heart failure
      • Cardiovascular disorders such as high blood pressure, high cholesterol or coronary artery disease, and
    • You reach $4,044 in yearly prescription drug costs paid by you and the plan.*

    If you are eligible, we will mail you a letter. Also, you may receive a call, inviting you to participate in this one-on-one medication review. This call may come from:

    • a pharmacy where you recently filled one or more of your prescriptions. You will be given the option to choose an in-person review or a phone review.
    • a call from a pharmacist at the clinic where your provider works. These reviews are typically conducted by phone.
    • a call center pharmacist may reach out to provide your review, and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.
  • How could the MTM program benefit me?

    It's estimated that 1.5 million preventable adverse drug events occur in the United States each year. Pharmacist-provided MTM services can help to prevent these events and are associated with improved medication use, lower drug costs, improved disease management, reduced hospitalizations, and reduced hospital readmissions.

    The MTM program provides you with a comprehensive medication review and a targeted medication review

    Comprehensive Medication Review

    The review is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:

    • Prescription drugs
    • Over-the-counter (OTC) medicines
    • Herbal therapies
    • Dietary supplements and vitamins

    The pharmacist will offer ways to manage your conditions with the medications you take. If more information is needed, the pharmacist may contact your prescribing doctor. The review takes about 30 minutes and is usually offered once each year to eligible members. At the end of your discussion, the pharmacist will provide you a Personal Medication List with the medications you discussed during your review.

    You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

    This review with a pharmacist is important. Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:

    • Discuss how your prescription drugs and OTC medications may affect each other
    • Identify any prescription drugs and OTC medications that may cause side effects and offer suggestions to help
    • Help you get the most benefit from all of your prescription drugs and OTC medications
    • Review opportunities to help you reduce your prescription drug costs

    Targeted Medication Review

    With this review, we mail, fax or call your doctor with suggestions about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them. We may also contact you, by mail or phone, with suggestions about your medications.

  • Tips to get the most out of your MTM program appointment
    1. Schedule your appointment at a time when you will not be interrupted or distracted.
    2. Be sure to have a list of all your medicines handy, including your over-the-counter drugs, herbal medicines, and supplements.
    3. Have a pen and paper to take notes.
    4. Write down questions you may have about your medicines before your appointment.

      Examples of common questions include:

      • What is the purpose of this medicine?
      • How and when do I take this medicine?
      • What should I do if I miss a dose?
      • Does this medicine have any side effects?
      • What should I do if a side effect occurs?
    5. Be ready and available at the agreed upon time for your telephone appointment.
    6. Schedule your convenient Medication Therapy Management (“MTM”) telephone appointment three to four weeks before your annual wellness exam with your physician.

    The MTM Pharmacist can help you organize your concerns and questions. This can help you make the most of your appointment time with your physician.

  • What if I have questions?

    To contact customer service or to obtain a Personal Medication List form, please call the Medication Therapy Management line at 888-850-8526 (TTY/TDD: 711) Monday – Friday, 8 a.m. – 8 p.m., (7 days a week, 8 a.m. – 8 p.m., October 1 – March 31).

Premera customers may call our customer service department at 855-339-5205 (TTY/TDD: 711) Monday – Friday, 8 a.m. – 8 p.m., (7 days a week, 8 a.m. – 8 p.m., October 1 – March 31, excluding Thanksgiving and Christmas).

© 2019 Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association serving businesses and residents of Alaska and Washington state, excluding Clark County. Premera Blue Cross is an HMO plan with a Medicare contract. Enrollment in Premera Blue Cross depends on contract renewal. ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 888-850-8526 (TTY: 711), April 1 - September 30, Monday - Friday, 8 a.m. - 8 p.m.; October 1 - March 31, 7 days a week, 8 a.m. to 8 p.m.To join a Premera Blue Cross Medicare Advantage Plan, you must have Medicare Part A and Part B and live in the Premera Blue Cross Medicare Advantage service area (Island, King, Pierce, Lewis, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, and Whatcom counties in Washington). Members must select a Primary Care Provider (PCP) from the Premera Blue Cross Medicare Advantage Plans provider network. For accommodation of persons with special needs at sales meetings, call 888-868-7767 (TTY/TDD: 711), April 1 - September 30, Monday - Friday, 8 a.m. - 8 p.m.; October 1 - March 31, 7 days a week, 8 a.m. to 8 p.m.