Our Medication Therapy Management (MTM) program is a partnership to help ensure that members have a safe, effective medication plan.
Horizon Blue Cross Blue
Shield of New Jersey
(Horizon BCBSNJ) offers
a free program to help certain
members who participate in our Medicare
Part D plans. This program is called
Medication Therapy Management
(MTM). Off ered at no charge to you, the
MTM program is designed to help improve
clinical outcomes and decrease medication
problems among Horizon BCBSNJ
members. Through the program, we
work with our members and their
physicians to make sure that medications
are used safely and correctly.
Members who qualify are automatically enrolled in the MTM program.* We identify members for eligibility in the MTM program through their prescription medication claims history. To be eligible, a member must meet all the following conditions. The program is available to members who:
- Have at least two chronic medical conditions,
- Take five or more prescription medications that are covered by Medicare Part D, and
- Spend more than $4,000 a year (or at least $1,000 per quarter) for medications that are covered by Medicare Part D.
What We Do
If you are a Horizon BCBSNJ member who is
eligible for the MTM program, a Horizon clinical
pharmacist will review your medication profi le to
make sure that your medication plan is working
for you. During this review, the pharmacist will
make sure that:
- Your medications are prescribed in the proper dosage
- Your medications do not interact with each other to cause side effects
- You are not taking two forms of the same medicine
- You are taking your medications regularly and according to the treatment plan outlined by your physician
- Your medication plan includes medicines that are recommended for you according to nationally recognized guidelines
- You are reaching treatment goals, such as keeping your cholesterol levels low if you take a medication to help lower your cholesterol levels
How We Can Help
If you are in the Medication Therapy Management (MTM) program from Horizon BCBSNJ, you will receive
free, personalized help from a clinical pharmacist. This includes:
- Professional review of your medication profile. If our review finds an issue related to your medication plan, our pharmacist will let your physician know by phone, fax, or mail. For example, if our records show that you have filled prescriptions for two medications that may interact with each other, we will contact your physician to let him or her know. Our pharmacist may also contact the pharmacy where the prescription was filled. This is to make sure that you are taking your medications correctly and safely.
- Support from a clinical pharmacist. If our pharmacists identify an issue related to your medication plan, they may contact you. Typically, this will be to make sure that you are taking your medications regularly, to see if you are having any side effects, and to ensure you are meeting your treatment goals. These steps are to help you take your medications correctly and stay healthy.
Did You Know?
The MTM program is designed to
help you take your medicines as
safely and effectively as possible.
Failing to take prescription medications
correctly is the number one problem in
treating illness today, according to the
American Heart Association.
* Eligible members are automatically enrolled in the MTM program but do not have to take part in it. You can opt out of the MTM program by calling the toll-free number on your Horizon BCBSNJ ID card.
