Medication Therapy Management (MTM) Program

What is the MTM program?

CommunityCare Senior Health Plan offers a Medication Therapy Management (MTM) program to members who qualify. The purpose of the program is to check that you are receiving the most effective medications. The program also helps reduce the risk of side effects and interactions and may lessen your out-of-pocket costs. This program was developed for us by a team of pharmacists and doctors. We use the Medication Therapy Management program to help us provide better coverage for our members.

How do I qualify for the MTM program?

The MTM program is designed to help members who meet the below criteria to get the most from their medications:

  1. You have 3 or more chronic health problems. These may include:
    • Asthma
    • Chronic Heart Failure (CHF)
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Depression
    • Diabetes
    • High blood fat levels (Dyslipidemia)
    • High blood pressure (Hypertension)
    • HIV/AIDS
    • Osteoporosis
    • Rheumatoid Arthritis
  2. You take 8 or more daily medicines that are related to your qualifying chronic conditions and covered by Medicare Part D.
  3. You are likely to incur a yearly drug spend of $3,919 or more.

Is there a cost for the MTM program if I qualify?

No, there is no additional cost to you. The MTM program is paid in full by CommunityCare Senior Health Plan. The MTM program is a requirement of all Part D plans and is not considered a separate benefit. This means that you can participate in the program without any change to insurance benefits, co-pays, prescription coverage, or available doctors or pharmacies.

How will I be contacted?

Members who meet the program criteria are sent a welcome letter describing the MTM program. A template of a welcome letter is available for your reference below.

You will also be contacted by a specially trained pharmacist for a Comprehensive Medication Review (a brief medication consultation to review your medications) and to answer any questions that you may have. This consultation usually takes 15 to 20 minutes and may be done by phone or at your local pharmacy. Detailed medication reviews may also be provided to your doctor throughout the year. This is referred to as a Targeted Medication Review. The specially trained pharmacists will work closely with you and your doctors to solve any problems related to your medications and to help you get the best results.

What happens after the consultation?

Following the consultation, the pharmacist will provide you with a medication review package which contains several helpful documents all related to your medication therapy and consultation. Templates of a Personal Medication List and a Medication Action Plan are available for your reference below. The MTM program monitors your medications on an ongoing basis. Reviews are offered once a year but may occur more frequently if you are diagnosed with new disease states or start new medications.

Is participation in the MTM program voluntary?

Yes. Medicare requires that MTM programs automatically enroll those who qualify throughout the calendar year, but participation is voluntary. You have the opportunity to opt-out of the program at any time. Once you have been enrolled, you will remain enrolled through the calendar year unless you opt-out or leave CommunityCare Senior Health Plan.

Need more Information?

If you have questions about the MTM program, you may contact OptumRx to speak with the MTM Department at 1-866-352-5305. (TTY users dial 711), Monday – Friday, 8am to 8pm CST.

You can also contact our Member Services Department at 1-800-642-8065 if you have any questions. Member Services Representatives are available Monday through Friday from 8am to 8pm, CST. From October 1, 2016 through February 14, 2017, Member Services hours will include Saturdays, Sundays and some Holidays. TTY/TDD users should call 1-800-722-0353.

If you would like to contact Senior Health Plan via mail, please use the following address:

Senior Health Plan Member Services
CommunityCare HMO
P.O. Box 3327
Tulsa, OK 74101-3327

You can also get information about the Medicare program and Medicare health plans by visiting www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). Medicare customer service representatives are available 24 hours a day, seven days a week to answer questions about Medicare. TTY/TDD users should call 1-877-486-2048.

Disclaimers

  • You may join or leave a plan only at certain times. Please call Senior Health Plan at the telephone number listed in the previous section of this web page or 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048. You can call this number 24 hours a day, seven days a week.
  • You can join Senior Health Plan if you are entitled to Medicare Part A and enrolled in Medicare Part B and live in the service area. However, individuals with End Stage Renal Disease are generally not eligible to enroll in Senior Health Plan unless they are members of our organization and have been since their dialysis began.
  • Senior Health Plan has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. You can ask for a current Provider Directory for an up-to-date list or search the Senior Health Plan provider directory on this website. If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither Senior Health Plan nor Original Medicare will pay for these services.
  • You must continue to pay your Medicare Part B premium, even if the Senior Health Plan premium is $0.