IEHP offers Medication Therapy Management (MTM) to qualified members. MTM is a term used to describe a broad range of services offered by pharmacists on our health care team.
The IEHP Clinical Pharmacy team reviews your medicines, making sure you’re taking the right ones for your health conditions. If you are a member who qualifies for the MTM Program, you will receive a letter from us. You will be enrolled - unless you opt-out. The program costs $0 for those who qualify.
Who might be eligible?
Members will be enrolled in IEHP DualChoice (HMO D-SNP) and must meet specific criteria to receive the following services
- Medicine therapy reviews
- Medicine education - includes a medication action plan
- Disease management
Our IEHP Clinical Pharmacy Team will review your medicines, family history, disease states and goals for medicine therapy. Based on a full review, this team then offers recommendations to you and your providers.
A team of registered pharmacists and technicians work with your doctor (or other provider), pharmacies, and our Care Management teams to offer a “whole health” care approach to you.
Medicare MTM Program
IEHP Clinical Pharmacy offers the MTM services at no extra cost for IEHP DualChoice Members who:
- Have a number of health issues and
- Are taking many prescription drugs and
- Have high medicine costs
Members with an active coverage limitation under a Drug Management Program (DMP) are also offered the MTM services.
Once enrolled in this voluntary program, you will get a welcome packet by mail with details on next steps. You’ll also get information on how to disenroll, should you choose not to be in the program. If you decide not to take part in the program, your enrollment and eligibility with IEHP DualChoice will not change. We hope that if you qualify that you will take part in this program that is offered free of charge—to help you better manage your medicines.
The MTM program includes a yearly comprehensive medication review (CMR), targeted medication review (TMR), and annual safe disposal information. Here are some details on MTM services:
| Comprehensive Medication Review (CMR) | Every year you qualify, an IEHP Clinical Pharmacist will call you to review your medications by phone. The Pharmacist will go over all your medicines (prescription, over the counter, and supplements) to make sure you have the right ones for your conditions and that you avoid drug interactions.
Once your CMR is done, you will get your Medication Action Plan (MAP) and Personal Medication List (PML) by mail within 14 days. These documents can be accessed by calling Member Services and asking to speak to the Clinical Pharmacy Team. |
|---|---|
| Targeted Medication Review (TMR) | The IEHP Clinical Pharmacy Team will also complete TMRs through the year by reviewing issues with your medicines. The team will perform TMRs for all enrolled beneficiaries every three months. You may get TMR recommendations by mail and your Primary Care Provider may receive recommendations by fax—if the IEHP Clinical Pharmacy Team deems it necessary. |
| SAFE DISPOSAL INFORMATION | Annually, you will also receive information on the safe disposal of prescription medications that are controlled substances. |
For more information, IEHP DualChoice Members eligible for CMR or TMR services can call 1-877-273-IEHP (4347), 8 a.m.-8 p.m. (PST), 7 days a week, including holidays. TTY users should call 1-800-718-IEHP (4347). Click here for a blank personal medication list.
Eligibility Criteria
These MTM Program services may have limited eligibility criteria and are not considered a benefit. They are available for these conditions:
1. The member has a minimum of three (3) disease states:
- Bone Disease-Arthritis-Osteoporosis
- Chronic Heart Failure (CHF)
- Diabetes
- Dyslipidemia
- End-Stage Renal Disease (ESRD)
- HIV/AIDS
- Hypertension
- Mental Health Chronic/ Disabling Mental Health Conditions
- Respiratory Disease – Asthma
- Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD)
2. The member is prescribed a minimum of five (5) different medications to treat those disease states:
- ACE-Inhibitors
- Angiotensin II Receptor Blockers (ARBs)
- Antidepressants
- Antihyperlipidemic
- Antihypertensives
- Antipsychotics
- Antiretroviral Therapy
- Beta Blockers
- Bisphosphonates
- Bronchodilators
- Calcium Channel Blockers
- Diuretics
- Insulins
- Oral Hypoglycemics
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Inhaled Corticosteroids
- Calcimimetic
- Cardiac Glycoside
- Colony Stimulating Factors
- Glucagon-Like Peptide-1
- Glucocorticosteroids
- Neprilysin Inhibitor
- Phosphate Binders
- Vitamin D Analogs
3. Drug costs of $1332.50 (one-fourth of $5,330) for the previous three months are likely to be incurred.
To learn more about MTM, call IEHP DualChoice at 1-877-273-IEHP (4347), 8 a.m.-8 p.m. (PST), 7 days a week, including holidays. TTY users should call 1-800-718-IEHP (4347).
IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal.
Information on this page is current as of April 02, 2024.
H8894_DSNP_24_4651029_M_2024_A Accepted
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