Medication Therapy Management
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.
If you have any questions about this program, please contact Customer Service at 1-877-723-4795, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711.
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 medication costs and drug reactions
- How best to take your medications
- Any questions or problems you have about your prescription and over-the-counter medication
After the call, you 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’re taking and explains why you take them.
Every three months, a pharmacist or other health professional may follow up with you to make sure:
- Your records are up to date
- Your medications are working well together
- Your medications are cost effective
You may be eligible 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:
- Have at least 2 of these chronic diseases:
- Chronic Heart Failure (CHF)
- Dyslipidemia (high cholesterol)
- Hypertension (high blood pressure)
- Chronic Obstructive Pulmonary Disease (COPD)
- Be on at least 7 different maintenance medications
- Annual cost of at least $3,967 per year on those medications
The MTM program is free to members who qualify. 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. 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 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 review, 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/TDD 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! When you request a CMR, we schedule a telephone appointment for you.
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.
If you do not opt out of the MTM program, but you do not request a CMR, the MTM program will review your medications every three months. These reviews, called Targeted Medication Reviews (TMRs), help to identify problems with your medications. Based on your TMRs, we may contact you to offer you a CMR.
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’ll also get a Personal Medication List that will include all the medications you’re taking 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/TDD users, please call 1-800-367-8939 or 711.
You may also download a blank copy of the Personal Medication List from Member Materials.
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, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. The call is free.
(8:00 a.m. - 8:00 p.m.
Monday - Friday)
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.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. Benefits and/or copays may change on January 1 of each year. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you. Copays for prescription drugs may vary based on the level of Extra Help you get. Please contact the plan for more details.
Last updated 12/29/2017