Medication Therapy Management

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. In addition, you'll get information about safe disposal of prescription medications that are controlled substances.

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.

You may qualify for the MTM program if you meet specific criteria. The MTM program is not considered a benefit of SCFHP DualConnect. 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 $4,935 on covered Part D drugs in 2023

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 available to SCFHP DualConnect members who qualify at no cost.

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.

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, MedWiseRx, at 1-844-866-3735 (TTY: 1-800-367-8939), Monday through Friday, 7 a.m. to 5 p.m. This review is most helpful if it can be completed before you see your provider for your annual wellness visit.

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

A CMR is a one-on-one telephone conversation between you or your authorized representative and a pharmacist or other health professional. During the CMR, the pharmacist reviews 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.

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, your authorized representative, or your doctor.

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, MedWiseRx, toll-free at 1-844-866-3735 (TTY: 1-800-367-8939), Monday through Friday, 7 a.m. to 5 p.m.

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

You can ask for published materials for free in other formats, such as large print, Braille, or audio. Call SCFHP DualConnect Customer Service for help.

If you are more comfortable speaking a language other than English, Santa Clara Family Health Plan can help you. Whether you are contacting SCFHP or visiting a doctor, we have interpreters available. Tell your doctor you would like an interpreter for your visit.

Know your rights

• You can get an in-person or telephone interpreter at no cost to you. This includes American Sign Language.
• When you go to the doctor, interpreters are available 24-hours a day.
• You can ask for SCFHP DualConnect materials written in other languages.

How can you get an interpreter?

Tell your doctor’s office you would like one. You can do this when you call to set up your next visit. You can also ask us for an interpreter or for translated materials.