Medication Therapy Management

About the Medication Therapy Management (MTM) or Medicine Review Program

The Medication Therapy Management (MTM) Program, also known as the Medicine Review Program, can help you stay healthy. The program gives you the tools you need to get the most from your medicines. The MTM Program is offered to members of OneCare (HMO SNP) at no cost.

We choose members who are at the highest risk for medicine problems. The MTM program offers a pharmacist consultation at no cost. Our MTM trained pharmacists teach you how to take your medicine in a safe and proper way. Taking your medicine the correct way helps prevent drug side effects and can lower your out-of-pocket costs.

Comprehensive Medicine Review

As part of the MTM Program, a pharmacist does a comprehensive medication review (CMR) with you. We can do the CMR with you in person or over the phone. Your CMR may take 30 to 60 minutes.

During your CMR, the pharmacist looks at:

  • Why you are taking each of your medicines
  • If the medicines you are using are working for you
  • If your medicines are causing any side effects or making you sicker
  • If your medicines effect each other, foods or over-the-counter medicines
  • If there are ways to lower the number of medicines you are taking

After meeting with a pharmacist, we will mail you 2 documents:

  • Medication Action Plan (MAP): This document shows you steps you can take to get the most out of your medicines.
  • Personal Medication List (PML): This document lists all your medicines, how you take them and why you take them.

You may download a blank PML to track other medicines or update your list.

Also as part of the MTM program, a pharmacist performs targeted medication reviews (TMR) at least once each quarter. During the TMR, the pharmacist looks at only some of the medicines you take to see if there are problems that could put you at risk. If the pharmacist finds that you are at risk for medicine problems, the pharmacist tells your doctor.

MTM Eligibility Requirement

Once a quarter, we select members to take part in the MTM program. If chosen, we will send you a letter in the mail telling you about it.

You are chosen for MTM if all of these apply to you:

  • You receive medicines for 3 or more of the following conditions:
    — Diabetes
    — Asthma
    — Chronic Obstructive Pulmonary Disease (COPD)
    — Hypertension or high blood pressure
    — Dyslipidemia or high cholesterol
    — End-Stage Renal Disease (ESRD)
  • You are taking eight or more medicines through OneCare per quarter
  • You will likely exceed $4,044 in medicine costs per year

If you do not wish to be entered in this program, please call OneCare Customer Service to opt out.

To learn more about our MTM Program or to opt out, please call OneCare toll-free at 1-877-412-2734. You can call 24 hours a day, 7 days a week. Or you can visit our office Monday through Friday, from 8 a.m. to 5 p.m. TDD/TYY users can call toll-free at 1-800-735-2929. We have staff who speak your language.

To file a complaint with Medicare, click on the following link to complete a complaint form on the Medicare website: Medicare Complaint Form.

H5433_19MM055_M Accepted (12/30/18)

OneCare (HMO SNP) is a Medicare Advantage organization with a Medicare contract. Enrollment in OneCare depends on contract renewal. Eligible beneficiaries can enroll at any time. Eligible beneficiaries must have Part A and Part B to enroll in the plan. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. Other Pharmacies/Physicians/Providers are available in our network. Medicare beneficiaries may also enroll in OneCare (HMO SNP) through the CMS Medicare Online Enrollment Center located at Medicare has neither reviewed nor endorsed this information. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. OneCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This information is available for free in other languages. Please call our customer service number at 1-877-412-2734, 24 hours a day, 7 days a week. TDD/TTY users should call 1-800-735-2929.

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