Our Medication Therapy Management (MTM) program can help our members who have special situations manage their medications.

Members who have three or more of the following medical conditions, and take many drugs at the same time, and have very high drug costs, are likely to be eligible for our program.

• Bone Disease (Osteoporosis)
• Respiratory Disease (Chronic Obstructive Pulmonary Disease)
• Chronic Heart Failure
• Diabetes Mellitus
• End-Stage Renal Disease (on dialysis)
• Cerebrovascular Disease
• Cirrhosis
• Atrial Fibrillation
• Myocardial Infarction

This program is voluntary and free to members. A team of pharmacists and doctors developed the program for us. The program can help make sure that our members are using the drugs that work best to treat their medical conditions and help us identify possible medication errors.

This program is not a benefit; therefore if you qualify for our program based on our criteria, we will automatically enroll you in the program and send you information. If you decide not to participate, please notify us and we will withdraw your participation from the program.

If you have any questions, you may contact our Member Services Department at 1-888-540-7226. We are available to help you between the hours of 7:00 a.m. and 8:00 p.m., seven days a week. TTY users may call 1-800-367-8939.

Utilization Management (EOC Language)

For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. A team of doctors and/or pharmacists developed these requirements and limits for our Plan to help us provide quality coverage to our members. Please consult your copy of our formulary or the formulary on our web site for more information about these requirements and limits.