IEHP offers Medication Therapy Management (MTM) to qualified members. MTM is a term used to describe a broad range of services offered by pharmacists on our health care team.
The IEHP Clinical Pharmacy team reviews your medicines, making sure you’re taking the right ones for your health conditions. If you are a member who qualifies for the MTM Program, you will receive a letter from us. You will be enrolled - unless you opt-out. The program costs $0 for those who qualify.
Who might be eligible?
- Some members who have been identified for this program may have only Medi-Cal coverage with IEHP.
- Or they may be enrolled in IEHP DualChoice (HMO D-SNP). They must meet the criteria and will receive the services for the Medicare MTM Program. (See description below.)
What are MTM services?
IEHP’s MTM services include these core elements:
- Medicine therapy reviews
- Medicine education - includes a medication action plan
- Disease management
Our IEHP Clinical Pharmacy Team reviews the member’s medicines, family history, disease states and goals for medicine therapy. Based on a full review, this team then offers recommendations to the member and providers.
A team of registered pharmacists and technicians work with your doctor (or other provider) and pharmacies to offer full care. We also work with our care management teams to offer “whole health” care to our members.
Medicare MTM Program
IEHP Clinical Pharmacy offers the MTM services at no extra cost for IEHP DualChoice Members who:
- have a number of health issues and
- are taking many prescription drugs and
- have high medicine costs
Once enrolled in the program, you will get a packet by mail with details. You’ll also get information on how to disenroll, should you choose not to be in the program. If you decide not to take part in the program, your enrollment and eligibility with IEHP DualChoice will not change. We hope that if you qualify that you will take part in this program that is offered free of charge—to help you better manage your medicines.
The MTM program includes a yearly comprehensive medication review (CMR) and targeted medication review (TMR). Here are some details on MTM services:
|Comprehensive Medication Review (CMR)||An IEHP Clinical Pharmacist will give you a full yearly review of your meds by phone. The Pharmacist goes over your medicines to make sure you have the right ones for your condition and that you avoid drug interactions and more. |
Once your CMR is done, you will get your Medication Action Plan (MAP) and Personal Medication List (PML) by mail. MTM services documents, with a copy of a Personal Medication List, can be accessed by calling Member Services and asking to speak to the Clinical Pharmacy Team.
|Targeted Medication Review (TMR)||The IEHP Clinical Pharmacy Team will also offer TMRs through the year by reviewing issues with the participating IEHP DualChoice Member’s medicines. The team will perform TMRs for all enrolled beneficiaries every three months. The beneficiary may get TMR recommendations by mail and their Primary Care Provider may receive recommendations by fax—if the IEHP Clinical Pharmacy Team deems it necessary.|
These MTM Program services may have limited eligibility criteria and are not considered a benefit. They are available for these conditions:
1. The member has a minimum of three (3) disease states:
- Bone Disease-Arthritis-Osteoporosis
- Chronic Heart Failure (CHF)
- End-Stage Renal Disease (ESRD)
- Mental Health Chronic/ Disabling Mental Health Conditions
- Respiratory Disease – Asthma
- Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD)
2. The member is prescribed a minimum of five (5) different medications to treat those disease states:
- Angiotensin II Receptor Blockers (ARBs)
- Antiretroviral Therapy
- Beta Blockers
- Calcium Channel Blockers
- Oral Hypoglycemics
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Inhaled Corticosteroids
- Cardiac Glycoside
- Colony Stimulating Factors
- Glucagon-Like Peptide-1
- Neprilysin Inhibitor
- Phosphate Binders
- Vitamin D Analogs
3. Drug costs of $1,332.50 (one-fourth of $5,330) for the previous three months are likely to be incurred.
IEHP DualChoice (HMO D-SNP) is a HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) is dependent on contract renewal.
Information on this page is current as of October 01, 2023.
H8894_DSNP_24_4164896_M Pending Accepted