Medication Therapy Management (MTM)

Medication Therapy Management (MTM) is a service provided by pharmacists and other healthcare professionals to discuss all of your medications in detail. The purpose of this program is to ensure optimum outcomes for you through improved medication use. We accomplish this by increasing your knowledge regarding your medications and improving your understanding about your health conditions. Our pharmacists work with your physician(s) to ensure the benefits of participating in this program are improved medication therapy outcomes.

Do you take several medications?

Do your medications change frequently?

Are your medications too expensive?

Do you see multiple doctors or specialists?

Do you have a chronic health condition managed by medication?

Do you take vitamins, minerals, or any other supplements with your medications?

If you answered YES to any of these questions, and you qualify for the MTM program (qualifications listed below in the section entitled “Who Qualifies for MTM?”), you may want to consider participating in our Medication Therapy Management Program.

Summary of Our Services

Members qualify for MTM services based on the criteria listed below (in the section entitled “Who Qualifies for MTM?”) on a quarterly basis. Once you qualify for the MTM program, you are automatically enrolled. When becoming enrolled, you will receive a welcome packet in the mail within the first 60 days of becoming eligible that explains how you can participate in the program. Additionally, you will receive a second offer by telephone inviting you to participate in the MTM program. Once you decide to participate, we will do a comprehensive medication review (also known as CMR) where we will address any concerns you have with your medications, including cost issues and drug reactions, discuss how best to take your medications and answer any questions you have about your medications and health conditions. This review is done over the phone and typically lasts 10-15 minutes. The length of the call may be longer or shorter depending on your specific needs. After the comprehensive medication review is complete, our pharmacists review your therapy goals, look at your medication regimen and reach out to your physician(s) to make recommendations to improve your medication therapy outcomes, if needed. Our goal at Granite Alliance is to help you receive the most benefit from the medications you take.

Once enrolled in the MTM program, an additional service you will receive are targeted medication reviews (also known as TMRs). These are reviews based upon specific clinical issues and are completed quarterly. Targeted medication reviews are sent as letters and/or faxes to you and/or your prescriber regarding the information reviewed. If the specific issue is deemed to warrant additional outreach, a follow up call may be necessary to you and/or your prescriber to ensure optimum therapy is achieved.

What you receive when participating

Personal phone call from our specialized Clinical Team
A Medication Action Plan for you to discuss with your doctor
A Personal Medication List to keep track of the medications you are taking and why
Letter sent to your physician(s) with the information we discussed as needed
Letters periodically sent to you and/or your physician if issues are found from a targeted medication review

Who Qualifies for MTM?

2024 Eligibility: Members must meet all of the requirements under #1 or #2 below to qualify for MTM services:

1.) a. Must have at least 3 of the following diseases :
Alzheimer's Disease
Bone Disease - Arthritis - Osteoporosis
Chronic Heart Failure (CHF)
Chronic Obstructive Pulmonary Disease (COPD)
Diabetes

b. Must be taking a minimum of 8 Part D medications

c. Must incur at least $1,332.50 towards Part D medications, including what your insurance paid and your copayments, in the previous three months.

2) Members with an active coverage limitation under a Drug Management Program.

What does it Cost to Participate in MTM?

Once you are qualified for the Medication Therapy Management Program, ALL MTM services are 100% FREE.

Were you enrolled and you're not interested?

If you qualify for the MTM program and you are not interested in participating, you may:

Opt out of the personal phone call and still receive items in the mail
Opt out of the entire program for the current plan year - OR
Opt out of the entire program permanently

You may notify us by mail, telephone, or email regarding your participation choice. Our contact information is located at the bottom of this page.

Some Considerations

MTM services are not a standard benefit, members must qualify in order to participate
Please contact your plan's customer service department for additional questions. Their toll-free number is located on your insurance ID card.