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Medication Therapy Management

If you take medications for different medical conditions, you may be able to get services, at no cost to you, through a Medication Therapy Management (MTM) program. This program helps you and your provider make sure that your medications are working to improve your health.

Medication Therapy Management programs are voluntary and free to members who qualify. If we have a program that fits your needs, we will enroll you in the program and send you information. If you do not want to be in the program, please let us know and we’ll take you out of the program.

If you have any questions about this program, please contact Santa Clara Family Health Plan (SCFHP) Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m.

What services are offered in a Medication Therapy Management program?

In the MTM program, a pharmacist or other health professional will review all of your medications and talk with you on the phone about:

  • How to get the most benefit from the drugs you take
  • Any concerns you may have, like possible drug side effects
  • How best to take your medications
  • Any questions you have about your prescription and over-the-counter medications

After the call, you will get a written summary of this discussion. The summary has a Medication Action Plan that helps you make the best use of your medications. You also get a Personal Medication List that includes all the medications you take and explains why you take them.

Every three months, we may contact you or your doctor if we find any issues with the drugs you are taking. These reviews, called Targeted Medication Reviews (TMRs), help to identify specific or potential problems from your medications.

Do you qualify?

You may qualify for the MTM program if you meet specific criteria. The MTM program is not considered a benefit of the SCFHP Cal MediConnect Plan. You must meet all of the following:

  • Have at least 3 of these chronic diseases:
    • Chronic heart failure (CHF)
    • Diabetes
    • Dyslipidemia (high cholesterol)
    • Hypertension (high blood pressure)
    • Asthma
    • Chronic obstructive pulmonary disease (COPD)
  • Be on at least 8 different maintenance medications
  • Be likely to spend at least $4,255 on covered Part D drugs in 2020

If you qualify for the MTM program, you will be automatically enrolled in the program and mailed a welcome letter that explains the program and how to ask for a medication review. The MTM program is free to members who qualify.

If you do not want to be in the MTM program, please let us know and we will take you out of the program. You can leave the program at any time.

How do you enroll in the MTM program?

If you meet the criteria for the MTM program, you will be automatically enrolled in the program. You will receive a welcome letter for the MTM program. The letter will explain the program and tell you how to ask for review of your medications with a pharmacist or other health care professional, called a Comprehensive Medication Review (CMR).

To schedule your CMR, complete and return the form you received with your welcome letter in the postage-paid envelope provided. Or, call our MTM partner, SinfoniaRx, at 1-844-866-3735, Monday through Friday, 7 a.m. to 5 p.m. TTY users, please call 1-800-367-8939 or 711. This review is most helpful if it can be completed before you see your provider for your annual wellness visit.

Call SinfoniaRx today to set up your pharmacist’s review!

What is a Comprehensive Medication Review (CMR)?

A CMR is a one-on-one telephone conversation with a pharmacist or other health professional. During the CMR, the pharmacist reviews with you all of the medications you take, including prescriptions, over-the-counter drugs (OTC), herbal supplements, and samples. The pharmacist also writes down on a Personal Medication List (PML) how to take your medications and explains why you take each medication. You also discuss the goals of taking your medications and any problems or questions you may have. Please allow at least thirty minutes for your CMR. The time required to review all your medications depends on many factors, and it may take longer. After the CMR, you will receive a follow-up letter that includes a Medication Action Plan detailing your conversation with the pharmacist, along with your Personal Medication List.

What if you do not complete a CMR?

Even if you do not complete a CMR, the MTM program will review your medications every three months as part of a Targeted Medication Review (TMR). TMRs help to identify specific or potential problems from your medications. If we find any issues with the drugs you are taking, we may contact you or your doctor.

Can you get a copy of your medication reviews?

Yes. After a review is completed, you will 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. You will also get a Personal Medication List that will include all the medications you take and why you take them. If you need additional copies or would like a blank copy, please call our MTM partner, SinfoniaRx, toll-free at 1-844-866-3735, Monday through Friday, 7 a.m. to 5 p.m. TTY users, please call 1-800-367-8939 or 711.

You may also download a blank copy of the Personal Medication List from Member Materials.

Accessibility

You can ask for published materials in other formats, such as large print, braille, or audio. Call Customer Service for help. This service is free.

If you speak a language other than English, language assistance services, free of charge, are available to you. Call Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. The call is free.

Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect) depends on contract renewal.

Last updated 05/23/2020

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