Policies & Procedures
Page last updated: Jan 24, 2022
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Care N’ Care has Medication Therapy Management (MTM) Program that can help our members with complex health needs. This program is voluntary and free to eligible members and is separate from the prescription drug plans that we already offer. A team of pharmacists and doctors at our Pharmacy Benefits Manager, Elixir, developed and maintains the program, which gives members additional support with their Part D medications. This program can help make sure that our members get the most benefit from the drugs they take.
We use criteria established by Medicare to identify eligible members. They must be filling at least eight Part D prescription drugs per month, have had an accumulated drug costs of at least $1,174.00 in the previous quarter, and have documented illnesses in at least three of these chronic conditions:
Every quarter, we automatically enroll qualified members in Care N’ Care’s MTM program so they may begin receiving this extra support. Eligible MTM members will receive a letter notifying them that they have been auto-enrolled into the MTM Program.
For each eligible member, a pharmacist or other health professional will give you a comprehensive review of all your medications. You can talk about how best to take your medications, your costs, and any problems or questions you have about your prescription and over-the-counter medications. You’ll get a written summary of this discussion. The summary has a medication action plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions. You’ll also get a personal medication list (PML) that will include all the medications you’re taking and why you take them. (You can access a blank PML here). We’ll also conduct ongoing Targeted Medication Reviews (TMRs); your doctor may be contacted if we identify any issues with your medications.
It’s a good idea to have your medication review before your yearly “Wellness” visit, so you can talk to your doctor about your action plan and medication list. Bring your action plan and medication list with you to your visit or anytime you talk with your doctors, pharmacists, and other health care providers. Also, keep your medication list with you (for example, with your ID) in case you go to the hospital or emergency room.
Although we encourage members to take advantage of our valuable program, you can opt-out. If you do not want to participate, or if you have questions, please call the Elixir Care Navigator Center at 1-866-342-2183 (TTY 711) weekdays from 9 a.m. to 5 p.m. (EST).