Medication Therapy Management

  • What is the Medication Therapy Management program?

    The Premera Blue Cross medication therapy management (MTM) 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?

  • You will be enrolled in the 2022 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 $4,696 in prescription drug costs in 2022

      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 quality. There is no extra cost to for the MTM program.

      How will I know if I quality 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.

    We will automatically enroll you in the 2021 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.
    • You reach $4,376 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.

  • 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.

    What services are included in the MTM program?

    In the MTM program, you will receive the following services from a health care provider:

    • Comprehensive medication review
    • Targeted medication review

    What is a comprehensive medication review?

    The comprehensive medication review is completed with a health care provider in person or over the phone. This review is a discussion that includes all of 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 health care provider may offer ways to help you manage our health and get the most out of your medications. If more information is needed, the health care provider may contact your prescriber.

    At the end of the review, the health care 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.

    Who will contact me about completing the review?

    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 health care 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.

    Why is this review important?

    Different prescribers may write prescriptions for you without knowing all the medications you take. For that reason, the MTM program health care 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

    How do I benefit from talking with a health care provider?

    By completing the medication review with a health care 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

    What is a targeted medication review?

    The targeted medication review is completed by a health care 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.

    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:
      1. What is the purpose of this medicine?
      2. How and when do I take this medicine?
      3. What should I do if I miss a dose?
      4. Does this medicine have any side effects?
      5. 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.

    How do I safely dispose of medications I don't need?

    The Premera Blue Cross MTM program is dedicated to providing you with information about safe medication disposal. Medications that are safe for you may not be safe for someone else. Unneeded medications should be disposed of as soon as possible. You can discard your unneeded medications through a local safe disposal program or at home for some medications.

    • Locating a community safe drug disposal site
      • A drug take back site is the best way to safely dispose of medications. To find a drug take back site near you, visit this site and enter your location.
      • Some pharmacies and police stations offer on-site drop-off boxes, mail-back programs, and other ways for safe disposal. Call your pharmacy or local police department (non-emergency number) for dispoal options near you.
    • Mailing medications to accepting drug disposal sites
    • Safe at-home medication disposal
      • You can safely dispose of many medications through the trash or by flushing them down the toilet. Visit this resource to learn more about safe at-home disposal
      • Follow these steps for medication disposal in the trash:
        • Remove medication labels to protect your personal information
        • Mix medications with undesirable substances, such as dirt or used coffee grounds
        • Place mixture in a sealed container, such as an empty margarine tub

    How can I get more information about the MTM program?

    Please contact us if you would like more information about the Premera Blue Cross MTM program or if you do not want to participate. Our number is 888-850-8526. TTY users should call 711. We are open 8 a.m. to 8 p.m., seven days a week from October 1 through March 31; 8 a.m. to 8 p.m., Monday through Friday from April 1 through September 30.