Medication Therapy Program Helps Seniors

In the spirit of guiding members toward better health outcomes, Humana is proud to introduce Medication Therapy Management (MTM).

“Humana has made a commitment to guiding its members to the information they need, when they need it, so that members can make confident choices,” said Nicholas Tabler, project manager. “The MTM program is part of that commitment.”

MTM is a federally mandated program by the Centers for Medicare & Medicaid Services (CMS), which requires that all health plans providing a Medicare Part D prescription drug benefit offer an MTM program accessible to a portion of its Medicare members.

In coordination with CMS, Humana has set eligibility requirements for MTM services for Humana Medicare members. Members are eligible for the services of Humana’s program if they have at least two chronic conditions, take at minimum of eight medications in a 90-day period for those conditions and are expected to spend at least $4,000 for the medications each year.

Humana’s MTM program will encompass a broad range of services designed to assist members in managing their medications and maximizing the benefits they receive from those medications. Tabler estimates 20 percent of Humana Medicare members will receive some MTM services, depending on their need and interest.

A number of different financial and medical topics will be covered, such as mail ordering, drug interactions, as well as a list of lower cost alternatives to the specific medication the member is taking.

“Humana will begin by inserting additional MTM messaging into the SmartSummary Rx for those members who qualify for MTM,” Tabler says. “MTM messaging will focus on the maintenance medications members fill regularly. Humana’s goal will be to increase the health literacy of its members, while alerting them of the problems and concerns they should be telling their physicians.”

MTM messaging will also offer the opportunity for select members to speak with a health care professional regarding their medication needs. Members receiving this invitation will be directed to the Humana MTM Call Center that will launch in the spring of 2006. The Humana MTM Call Center will be staffed with registered nurses and pharmacists who will provide members with recommendations they can take back to their physician.

Humana will also offer the opportunity for select members, through the MTM Call Center, to schedule appointments with pharmacists in their area to discuss their medication needs … at no additional cost. These MTM pharmacy appointments will go above and beyond the services that members currently receive by performing a comprehensive medication review, providing verbal education and training to enhance medication understanding, and assisting in formulating a medication treatment plan that will assist a member in getting the most out of his/her medications.

Members who participate in Humana’s MTM services will be encouraged to take recommendations back to their physicians for further discussion. In the event safety concerns are identified during an MTM pharmacy consultation, the pharmacist performing the consultation will contact the prescribing physician in order to review the recommendations.

“We believe the MTM program will improve member health by decreasing the occurrence of medication interactions that could potentially cause harm, provide a better understanding of the medications a member takes, and assist members and providers in finding lower cost alternatives for their medications,” says Tabler.

Humana encourages feedback from all health care professionals on how to improve services. Call (800) 281-6918 for any questions regarding MTM. Also, additional information about the program will be added to www.humana.com throughout 2006, including responses to frequently asked questions and a forum for provider feedback.

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