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Medication Therapy Management

Our Medication Therapy Management (MTM) program is a no-cost service designed to help you ensure that your medications are working best for you.

As part of the program, a pharmacist will complete a Comprehensive Medication Review (CMR) for eligible members. We automatically enroll members in our MTM program, if you qualify. Your participation is voluntary and you can opt out at any time.

What happens during a review?

During a review, you will talk with a pharmacist one-on-one and discuss the following:

  • All of your prescribed medications, over-the-counter products, and/or herbal medications.
  • Specific details about your medications including how they work, potential side effects, drug interactions, and any potential cost savings.
  • Pharmacist recommendations around treatment options and how to get the best outcome from your medication.

Following the review, we will send you a completed list of your medications and an action plan containing any recommendations from the pharmacist. We encourage you to share these with your primary care provider during your next visit to update their records. Should something serious be identified, the pharmacist will reach out to your doctor to help resolve it.

Who qualifies for the program?

On a quarterly basis, Arkansas Blue Medicare, in collaboration with Prime Therapeutics, will review prescription drug claims to determine eligibility in the program.

On a quarterly basis, Arkansas Blue Medicare, in collaboration with Prime Therapeutics, will review prescription drug claims to determine eligibility in the program.

To be eligible for the MTM program in 2021, a member must meet all three of the following criteria:

  • Have three or more of the following chronic conditions:
    • Diabetes
    • Dyslipidemia
    • Chronic Heart Failure
    • Chronic Obstructive Pulmonary Disease
    • Rheumatoid Arthritis
  • Be taking eight or more covered Part D drugs
  • Be likely to incur annual costs of Part D drugs that exceed $4,376

How do I know if I'm eligible?

After a review of prescription medications is completed, any eligible members will be sent an offer letter via mail describing the benefits of the program and how to complete the program. Additionally, you may receive outreaches via phone, email, or text messages.

Arkansas Blue Medicare partners with other health care organizations, who may assist in completing your CMR. These include retail pharmacies, Prime Therapeutics, Outcomes MTM Patient Engagement Team, and SinfoniaRx (Tabula Rasa Health Care).

What are Targeted Medication Reviews?

Every few months, the Medication Therapy Management Program will review your prescription drug claims to ensure that no additional issues or concerns are identified. If we do identify a potential problem, we may outreach to you or your doctor to review.

How do I complete my Comprehensive Medical Review?

Give us a call at 1-866-686-2223 (TTY 711) Monday to Friday 8:00 am to 5:00 PM CT. You can also email us at mtm@primetherapeutics.com.

How do I opt out of the program?

CMS requires us to automatically opt you into the program if you meet the criteria, but you are not required to participate. You can choose to opt-out by contacting Prime Therapeutics at 1-866-686-2223 (TTY 711) Monday to Friday 8:00 am to 5:00 PM CT. Opting out will not change any of your benefits or prescription drug coverage.

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Last updated 10/01/2020