Medicare Advantage Medication Therapy Management Program (2017)

For Classic (HMO-POS), Rewards (HMO), Value (HMO), and Employer Group plans

Health First Health Plans is excited to offer a Medication Therapy Management (MTM) Program at no additional cost for our qualified Medicare Advantage members. This program is not considered a covered benefit but is an extra service we provide to improve your care. Our MTM program is designed to assist members who may benefit from added support with their Part D drug benefits. The MTM program was developed by a team of pharmacists and doctors to offer support services beyond traditional pharmacy dispensing and counseling.

We use criteria established by Medicare to identify eligible members. A few of these guidelines include members who have multiple medical conditions, who are filling at least 8 prescription drugs per month, and/or who have high drug costs. A qualified member must accumulate drug costs exceeding $979.75 in one quarter and have documented illnesses in at least 3 of the following chronic conditions: Asthma, Chronic Heart Failure, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Dyslipidemia, Hypertension, Osteoporosis, Rheumatoid Arthritis.

We will automatically enroll qualified members in Health First Health Plans' MTM program so they may begin receiving this extra support. Although we encourage members to take advantage of our valuable program, you do have the option to opt out of the program. You may opt out by signing the bottom of your MTM enrollment form and mailing it back to Health First Health Plans at 6450 US Highway 1 Rockledge, FL. 32955. The MTM enrollment form will be mailed to each member who is automatically enrolled into the program. Remember, to participate in this supportive program, you do not need to do or pay anything additional.

While enrolled in the program, you will receive several additional services to include:

Targeted Medication Reviews: A Targeted Medication Review (TMR) is a service provided to target key drug therapy problems and/or medication safety concerns. You and/or the healthcare provider prescribing your medications may be contacted as a result of a TMR. If you are contacted, the review lasts approximately 10 minutes and can occur either over the telephone or face-to-face.

Comprehensive Medication Reviews: A Comprehensive Medication Review (CMR) is a consultation with a pharmacist or other qualified healthcare provider. The CMR takes approximately 30 minutes and may be conducted over the phone or face-to-face and can be conducted at a time convenient for you. A CMR will assess:

  • Why each medication is prescribed and whether any medications are potentially unnecessary.
  • If each medication is effective.
  • If each medication could be causing side effects, worsening other health conditions, or interacting with other medications.
  • If a medication regimen can be made more affordable or simplified (such as fewer pills or a more convenient dosing schedule).
  • If medications are being taken appropriately to get the most benefit from them.
  • If an additional medication could benefit your health.
  • If barriers exist which prevent you from taking your medication (such as transportation to the pharmacy, side effects or cost).

After the phone conversation, you will be provided with two documents via the mail:

  • A Medication Action Plan (MAP): Includes steps you should take to get the best results from your medications.
  • A Personalized Medication List (PML): Helps you keep track of your medications and how to use them properly. A blank PML to track additional medications is available for download. Click here

For questions, documents or to receive additional information about the our Medicare Advantage MTM program, please contact Customer Service.


Y0089_MP6408 Approved 5/11/2017
Last updated: 5/15/2017