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For Members

Medication Management (MTM) Program

In collaboration with FutureScripts® Secure, our pharmacy benefit manager, we offer a Medication Therapy Management (MTM) program to ensure that you are receiving the most effective medications, while also helping to reduce the risk of side effects and interactions as well as your out-of-pocket costs. The program is paid in full by your plan, at no cost to you. This program is not considered a benefit. There is no change to insurance benefits, co-pays, prescription coverage, or available doctors or pharmacies. Specially trained pharmacists will work closely with you and your doctors to solve any problems related to medicines and to help you get the best results.

Who is eligible for the MTM program?

The MTM program is designed to help you get the most from your medications if you meet the following criteria:

  • You have 3 or more chronic diseases including:
    • Bone/Joint Disease (i.e., Osteoporosis or Rheumatoid Arthritis)
    • Chronic Heart Failure
    • Diabetes
    • High Cholesterol
    • HIV/AIDs
    • High Blood Pressure
    • Mental Health Issues such as Depression or
    • Respiratory Diseases such as Asthma or COPD
  • You take 6 or more maintenance medications for chronic conditions
  • You spend $3,919 or more per year on Medicare Part D covered medications

What happens if you qualify for the program?

1. You will be sent an introduction letter describing the program to you.

2. You will receive a full medication review:

  • A specially trained pharmacist will contact you for an interactive person-to-person medication consultation to review all of your medications and answer any questions that you may have.
  • The pharmacist will also target areas of medication concerns such as:
    • High risk medications: if you are taking certain medicines that have a high risk of serious adverse effects when there may be safer drug alternatives
    • Medication adherence: if you are not taking certain diabetes, high blood pressure or high cholesterol medicines as prescribed
  • Following the consultation, you will be sent a summary of your Comprehensive Medication Review. The summary will contain a medication action plan for you to take notes or write down any follow-up questions.
  • Personal Medication List
  • Medication Action Plan

3. Your medications will be reviewed on an ongoing basis

  • At least every 3 months, your medicines will be reviewed and your MTM pharmacist will work with you, your doctor(s), if any changes are needed

Medication reviews are offered once a year, but may occur more frequently as you are diagnosed with new disease states or start new medications. Medicare requires that MTM programs automatically enroll those who qualify throughout the calendar year, but participation is voluntary, and you have the opportunity to opt out at any time. Once you have been enrolled, you will remain enrolled through the calendar year unless you opt-out or leave our plan.

If you have any questions about the MTM program, please call FutureScripts® Secure's MTM Department at 1-855-380-1228. (TTY: 711): Monday - Friday, 9 a.m. to 9 p.m. EST.

For more information, contact the Member Help Team.

If you are a member and have questions, contact the Member Help Team at 1-800-645-3965 for Keystone 65 HMO and 1-888-718-3333 for Personal Choice 65 PPO (711 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. However, please be aware that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail.

Website last updated: 1/1/2017
Y0041_HM_17_43499f Approved 1/6/2017