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Medication Therapy Management Program

Medication Therapy Management Program

Information Last Updated:10/18/2022

Medication Therapy Management for Plan Year 2022

What is the Brand New Day MTM program?

The Brand New Day MTM program helps you get the greatest health benefit from your medications by:

  • Preventing or reducing drug-related risks
  • Increasing your awareness
  • Supporting good habits

Who qualifies for the program?

We will automatically enroll you in the Brand New Day MTM program at no cost to you if meet the conditions of at least one of the following two groups (1) or (2):

  1. A) You take eight or more Medicare Part D covered maintenance drugs, AND

B) You have three or more of these long-term health conditions:

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic Heart Failure (CHF)
  • Diabetes
  • HIV/AIDs
  • Heart conditions such as high blood pressure, irregular heart rhythm, high cholesterol, coronary artery disease, and any other condition for which you take blood thinners.

C) You reach $4,696 in yearly prescription drug costs paid by you and the plan OR

  1. You are eligible for the Drug Management Program based on the Centers for Medicare and Medicaid Services (CMS) guidelines.

Your participation is voluntary and does not affect your coverage. This program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all members.

What services are included in the program?

The program provides you with a:

  • Comprehensive medication review (CMR), and
  • Targeted medication review if follow up is needed

Comprehensive Medication Review

  • 20-minute visit with an MTM Pharmacist
  • A Pharmacist will perform a review of all member medications (including prescription, over-the-counter(OTC) medications, herbal therapies, and dietary supplements) and medical conditions to determine if there are any drug therapy issues
  • If needed, the Pharmacist will work with the member’s provider to resolve any issues identified as part of the review
  • Within 14 days following the Comprehensive Medication Review, the Pharmacist will mail the member a Personal Medication List and a Medication Action Plan. The Personal Medication list summarizes their medication history. The Medication Action Plan summarizes any clinical concerns that were identified. Information may also be mailed to the member’s provider, based upon opportunities for medication therapy improvement.

The Pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the Pharmacist may contact your prescribing provider. The review takes about 20 minutes and is usually offered once each year — if you qualify. At the end of your discussion, the Pharmacist will provide you a Personal Medication List with the medications you discussed during your review.

You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your provider to discuss during your next doctor visit.

Here is an example of the Personal Medication List that you’ll walk through as a part of the program.

Targeted Medication Review

In addition, once every three months Brand New Day and our partners will perform a “Targeted Review” of the member’s medications. After each review, Bright HealthCare may contact the member’s provider with suggestions about medications that may be safer or a better alternative to the current therapy. As always, medications won’t change unless the member and their provider decide to change them.

How will I know if I qualify for the program?

If you qualify, we will mail you a letter. Also, you may receive a call, inviting you to participate in this one-on-one medication review.

Who will contact me about the review?

You may be contacted by a Pharmacist to provide your review and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.

Why is a review with a pharmacist important?

Different providers may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a Pharmacist will:

  • Discuss how your prescription drugs and OTC medications may affect each other
  • Identify any prescription drugs and OTC medications that may cause side effects and offer suggestions to help
  • Help you get the most benefit from all of your prescription drugs and OTC medications
  • Review opportunities to help you reduce your prescription drug costs

How do I benefit from talking with a pharmacist?

  • The Pharmacist will make sure you are taking your prescription, and OTC, medications safely
  • The pharmacist can look for ways to help you save money on your out-of-pocket prescription drug costs
  • You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with your doctors and health care providers

How can I get more information about the program?

If you would like additional information about our program, or if you do not want to participate after being enrolled, please call The Member Services Department at 1-877-468-0676, TTY 711, Monday - Friday 8 am - 8 pm.

Medication Therapy Management for Plan Year 2023

What is the Brand New Day MTM program?

The Brand New Day MTM program helps you get the greatest health benefit from your medications by:

  • Preventing or reducing medication-related risks
  • Increasing your awareness
  • Supporting good habits

Who qualifies for the program?

We will automatically enroll you in the Brand New Day MTM program at no cost to you if you meet the conditions of at least one of the following two groups (1) or (2):

    • A) You take eight or more Medicare Part D covered maintenance medications, AND
    • B) You have three or more of these long-term health conditions:
      • Asthma
      • Benign Prostatic Hyperplasia (BPH)
      • Diabetes
      • Dyslipidemia
      • Hypertension
      • Rheumatoid Arthritis (RA)
    • C) You reach $4,935 in yearly prescription drug costs paid by you and the plan, OR
  1. 2. You are eligible for the Drug Management Program based on the Centers for Medicare and Medicaid Services (CMS) guidelines. Your participation is voluntary and does not affect your coverage. This program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all members.

What services are included in the program?

The program provides you with a:

  • Comprehensive medication review (CMR), and
  • Targeted medication review if follow up is needed

Comprehensive Medication Review

  • 20 minute virtual visit with an AdhereHealth MTM Pharmacist
  • The Pharmacist will review of all your medications (including prescription, over-the-counter (OTC) medications, herbal therapies, and dietary supplements) and medical conditions to determine if there are any medication therapy issues
  • If needed, the Pharmacist will work with your provider to resolve any issues identified as part of the review
  • Within 14 days following the CMR, the Pharmacist will mail out a Personal Medication List summarizing your medication history and a Medication Action Plan if any concerns were identified. Information may also be mailed to your provider, based upon opportunities for medication therapy improvement.

The Pharmacist will offer ways to manage your conditions with the medications you take. If more information is needed, the Pharmacist may contact your prescribing provider. The review takes about 20 minutes and is usually offered once each year — if you qualify. At the end of your discussion, the Pharmacist will provide you a Personal Medication List with the medications you discussed during your review.

You will also receive a Medication Action Plan. Your plan may include suggestions from the Pharmacist for you and your provider to discuss during your next visit.

Here is an example of the Personal Medication List  that you’ll walk through as a part of the program.

Targeted Medication Review

In addition, once every three months Brand New Day and our partners, AdhereHealth, may perform a “Targeted Review” of your medications when follow up is needed after a CMR. After each review, Brand New Day may contact your provider with suggestions about medications that may be safer or a better alternative to the current therapy. As always, medications won’t change unless your provider decides to change them.

How will I know if I qualify for the program?

If you qualify, we will mail you a letter. You may also receive a call, inviting you to participate in this one-on-one medication review.

Who will contact me about the review?

You may be contacted by a Pharmacist to provide your review and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.

Why is a review with a Pharmacist important?

Different providers may write prescriptions for you without knowing all the prescription, and/or OTC medications you take. For that reason, a Pharmacist will:

  • Discuss how your prescription, and/or OTC medications may affect each other
  • Identify any prescription, and/or OTC medications that may cause side effects and offer suggestions to help
  • Help you get the most benefit from all your prescription, and/or OTC medications
  • Review opportunities to help you reduce your prescription medication costs

How do I benefit from talking with a Pharmacist?

  • The Pharmacist will make sure you are taking your prescription and OTC medications safely
  • The Pharmacist can look for ways to help you save money on your out-of-pocket prescription medication costs
  • You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with your healthcare providers

How can I get more information about the program?

If you would like additional information about our program, or if you do not want to participate after being enrolled, please call The Member Services Department at 1-877-468-0676, TTY 711, Monday - Friday 8 am - 8 pm.

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