TIER3 SUBLAYOUT

=========== TABBED SINGLE CONTENT GENERAL

Medication Therapy Management

IEHP offers Medication Therapy Management (MTM) to qualified Members. MTM is a term to describe a broad range of services offered by Pharmacists on our health care team.

The IEHP Clinical Pharmacy Team reviews the Members’ medicines, making sure they’re taking the right ones for their health conditions. If you are a Provider for IEHP Members who qualify for the MTM Program, you can let them know to look out for a letter from us. They will be enrolled automatically—unless they opt-out. MTM is offered to Members at no additional cost.

IEHP's MTM services include these core elements:

Medication therapy reviews
Medication education
Disease management

A team of Pharmacists and Doctors developed these MTM services to help provide better prescription drug coverage for our Members. For example, MTM also helps identify possible medication errors.

Medicare MTM Program

This is a free program under Medicare Part D for IEHP DualChoice Members who have multiple medical conditions, take many prescription drugs, and have high drug costs to assist with better medication management and overall health.

IEHP DualChoice Members’ enrollment includes a yearly comprehensive medication review (CMR) and regular targeted medication review (TMR) services throughout the year. MTM services include:

Comprehensive Medication Review (CMR)

An IEHP Clinical Pharmacist will provide an annual comprehensive review of the IEHP DualChoice Member’s medications over the phone. The Pharmacist will review IEHP DualChoice Member’s medications and make clinical recommendations to IEHP DualChoice Members and Providers.

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.

For more information, IEHP DualChoice Members eligible for CMR or TMR services can call 1-877-273-IEHP (4347), 8am-5pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Click here for a blank personal medication list.

Medicare MTM Program services may have limited eligibility criteria. They are available for the following conditions:

1. The IEHP DualChoice Member has a minimum of three (3) disease states:

Bone Disease-Arthritis-Osteoporosis
Bone Disease-Arthritis-Rheumatoid Arthritis
Chronic Heart Failure (CHF)
Diabetes
Dyslipidemia
End-Stage Renal Disease (ESRD)
Hypertension
Mental Health Chronic/ Disabling Mental Health Conditions
Respiratory Disease – Asthma
Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD)

2. The IEHP DualChoice Member is prescribed a minimum of five (5) different medications to treat those disease states:

ACE-Inhibitors
Angiotensin II Receptor Blockers (ARBs)
Antidepressants
Antihyperlipidemic
Antihypertensives
Antipsychotics
Beta Blockers
Bronchodilators
Calcium Channel Blockers
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
Diuretics
Insulins
Oral Hypoglycemics
Selective Serotonin Reuptake Inhibitors (SSRIs)
Tumor Necrosis Factors (TNFs)
Inhaled Corticosteroids
Calcimimetic
Cardiac Glycoside
Colony Stimulating Factors
Glucagon-Like Peptide-1
Glucocorticosteroids
Neprilysin Inhibitor
NSAIDs
Phosphate Binders
Vitamin D Analogs

3. Drug costs of $1,233.75 (one-fourth of $4,935) for the previous three months are likely to be incurred.

To learn more about MTM, call IEHP DualChoice (HMO-DSNP) at 1-877-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays.

TTY users should call 1-800-718-4347.

For answers to frequently asked questions, please download the FAQ document below:

MTM FAQs (PDF)

For details, contact the IEHP Pharmaceutical Services Department at (909) 890-2049, Monday-Friday, 8am-5pm.

IEHP DualChoice (HMO-D-SNP) [Medicare-Medicaid Plan] is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.

Information on this page is current as of March 2023.

H5355_CMC_20_1900233_Accepted

Pharmacy Pain Management (PPM)

The goal of the Pharmacy Pain Management (PPM) program is to proactively manage members on multiple opioid therapies to prevent overutilization, identify unsafe and inappropriate opioid use, and address potential fraud, waste, and abuse.

Identified members at risk of opioid overutilization will be evaluation through our Pharmacy Pain Management Program (PPM). A clinical team will be reviewing member therapy and reaching out to the primary provider to discuss the existence of multiple prescribing providers, member's total opioid utilization, appropriate level of opioid use for the member, and considerations for implementation of a member-level claim edit.

After review and consultation with the prescribing provider, if the member's therapy is determined to be appropriate and medically necessary, no further action will be taken. Results of consultation with provider and findings will be documented.

After review and consultation with the prescribing provider, if the member's therapy is determined to be inappropriate, and the provider recommends member-level point of sale claim edit, the member will be mailed a notification letter-that entrails the provider's recommendation. Medicare members will receive the notice 30 days in advance of the point of sale claim edit implementation.

Member may also be referred for evaluation and monitoring by a pain management specialist.

You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website.

Resources and Tools:

Pain Management CPG (PDF)
Pain Quick Reference Guide (PDF)

For convenience, the URL link to the State of California Department of Justice's Controlled Substance Utilization Review and Evaluation Systems (CURES), California Prescription Drug Monitoring Program (PDMP) site. By clicking on this link, you will be leaving the IEHP website. http://oag.ca.gov/cures-pdmp

Information on this page is current as of January 1, 2022

High Risk Medications Program

Notices

Reference

Medication Therapy Management

IEHP's MTM services include these core elements:

Medicare MTM Program

Medicare MTM Program services may have limited eligibility criteria. They are available for the following conditions:

1. The IEHP DualChoice Member has a minimum of three (3) disease states:

2. The IEHP DualChoice Member is prescribed a minimum of five (5) different medications to treat those disease states:

3. Drug costs of $1,233.75 (one-fourth of $4,935) for the previous three months are likely to be incurred.

For answers to frequently asked questions, please download the FAQ document below:

Pharmacy Pain Management (PPM)

Resources and Tools:

Rx PA Drug Treatment Criteria

Prescription Drug Prior Authorization (Rx PA) Drug Treatment Criteria

Drug Prior Authorization Criteria

Drug Class Prior Authorization Criteria

Pharmacy Policies

Miembros

Providers

Comunidades

Acerca de IEHP