Medication Therapy Management (MTM)

You and your covered dependents are eligible to enroll in the Medication Therapy Management (MTM) program if you take four or more UPlan-covered prescriptions and covered over-the-counter medications for chronic conditions or you are referred by your physician. When you participate in the MTM program, you meet with a specially trained pharmacist who will discuss your medication goals with you. The UPlan pays the full cost of the face-to-face consultations with the MTM pharmacist.

You should plan to see the MTM pharmacist three times during the first year, or more if needed, and two times in each subsequent year to provide an ongoing assessment of your health status and medications. 

Copay Reduction for Participation

Another incentive to participate is a copay reduction for UPlan-covered prescriptions and covered over-the-counter medications. You are eligible for a one-time copay reduction that lasts for six months.

• The copay reduction amount is $10, which results in zero cost for Generic Plus medications and a reduced copay of $20 for Brand Name medications on the UPlan formulary. With four medications you would benefit from a $240 reduction on copays in six months.
• The copay reduction amount for all three-month mail order prescriptions is $20, which results in zero cost for Generic Plus medications and a reduced copay of $40 for Brand Name medications on the UPlan formulary. With four medications through mail order you would benefit from a $160 reduction on copays in six months.

Choose Your MTM Pharmacist

Pharmacists included in the Directory of MTM Pharmacists have met credentialing standards developed by the UPlan. Specifically, all of the pharmacists have provided documentation that they have received education on the delivery of MTM during their degree program, or they have completed an additional, approved, continuing education course on providing MTM services.

MTM pharmacists are based out of clinics or community pharmacies. Because the MTM network is much smaller than the medical plan networks, it is possible that the MTM pharmacist you choose will not be part of your regular clinic or pharmacy. However, there is no need for you to change your prescription medications or your clinic to the MTM provider's location.

Enroll in the MTM Program

When you schedule your first visit, plan to bring the following items with you:

• Your medical plan and Prime Therapeutics ID card
• All of your prescription and over-the-counter medication bottles or a complete list of your current prescriptions, over-the-counter medications, herbals, vitamins, and supplements
• The UPlan MTM Program Member Participation Agreement (pdf)

During your first visit, you and your pharmacist will complete the Agreement and fax it to Prime Therapeutics at 1-877-254-3794 to initiate the copay reductions. The reductions are effective after the form is processed, which takes about seven business days.

What to Expect in Your First MTM Meeting

Your MTM consultation will be held in a private room in the pharmacy or the clinic where you will meet one-on-one with your MTM pharmacist. An initial visit may last from 30 to 45 minutes. The pharmacist will ask you questions about your medical conditions, your medical history, and current and past medication use. This information will be used to assess your current medications and identify any problems with your medications.

With your permission, the pharmacist will contact your primary care provider and present his/her assessment and recommendations. Your pharmacist will work closely with your primary care provider to make your health care as effective as possible and resolve any medication-related problems.

For Medica HSA Members

In the HSA plan, the deductible and coinsurance will apply, and you will be responsible for the cost of the consultations with the MTM pharmacist and your prescription medications. You may choose to use your HSA account to cover some costs. The benefit from participating comes from the helpful discussion with the MTM pharmacist and your increased understanding of your medications.

Questions

If you have questions on medication therapy management, first see the frequently asked questions (FAQs). If your question isn't answered in the FAQs, you may contact the Employee Benefits Service Center at the phone number or e-mail address shown below.