Pharmacy

What is Medication Therapy Management (MTM)?
Medication Therapy Management is a clinical program that provides education and information about your medicines. As part of this program, Harvard Pilgrim Stride members are provided with a pharmacist’s review of their medicines to look for ways to improve their drug therapy. Services offered through the MTM program include a Comprehensive Medication Review and Targeted Medication Reviews.

Who is eligible?
Members must meet the following three criteria to be eligible for MTM services:

1. Have at least 3 of the following chronic diseases:
   – Asthma
   – Chronic Obstructive Pulmonary Disease (COPD)
   – Chronic Heart Failure (CHF)
   – Diabetes
   – Dyslipidemia (high cholesterol)
   – Hypertension (high blood pressure)
2. Taking at least 8 Part D covered medications
3. Have at least $4,255 in estimated annual costs on Part D covered medications

What are the benefits of MTM?

• Pharmacists lower the risk of drug related problems, including medication errors and side effects
• Pharmacists offer helpful tips on how to take your medicines
• Pharmacists identify ways to reduce the cost of your medicines by eliminating duplicative therapy and suggesting lower cost formulary alternatives, if available

What is a Comprehensive Medication Review (CMR)?
A Comprehensive Medication Review is a one-on-one telephone or face-to-face consultation with a pharmacist during which the member’s entire medication profile is reviewed for appropriateness of therapy. The review includes all prescription medications, over-the-counter medications, herbal supplements, sample medications and should take no more than 20 minutes. Best of all, the CMR gives the member an opportunity to ask the pharmacist any questions he or she may have about the medications he or she is currently taking. Following the CMR, the pharmacist sends the member a Medication Action Plan and a Personal Medication List.

What is a Targeted Medication Review (TMR)?
During a Targeted Medication Review, a pharmacist looks for opportunities to improve a member’s medication regimen. Following a TMR, pharmacists may reach out to members and/or their providers via phone, mail or fax in order to discuss their findings. Targeted Medication Reviews are conducted on a quarterly basis for members who have not opted-out of the program.

How do I participate in the MTM program?
If you are eligible for the MTM program, you will receive a Welcome letter from our MTM partners at OptumRX. The letter will provide information about how to schedule your Comprehensive Medication Review with a pharmacist, which may be done by returning the enclosed form or by calling the provided toll-free number. OptumRx may also contact you by phone from their Medication Management Center to offer you a CMR.

For members not interested in participating in the MTM program, information regarding how to opt-out is also provided in the Welcome letter.

Participation in the MTM program is voluntary and available at no cost to Harvard Pilgrim Stride members. Participating in this program is not considered a covered benefit.

How do I find out more?
For questions regarding Harvard Pilgrim’s Medication Therapy Management program in partnership with OptumRx, call (866) 352-5305, Monday through Friday, 9:00 AM to 9:00 PM EST. For TTY users, call 711.

Harvard Pilgrim is an HMO/HMO-POS plan with a Medicare contract. Enrollment in Stride℠ (HMO) depends on contract renewal.