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Medication therapy management program

G.E.H.A can help you get the greatest health benefit from your medications.

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What is MTM?
The medication therapy management (MTM) program helps you get the most health benefit from your medications by:

  • Preventing or reducing drug-related risks
  • Increasing your medication knowledge and awareness
  • Supporting good medication habits
  • Ensuring you and your doctor choose medicines that are the best choice for you

Your participation is voluntary and does not affect your benefit coverage. There is no cost to eligible members who are invited to participate over the phone. The program is not considered a benefit.

MTM eligibility
You're automatically enrolled in the MTM program if you meet the criteria listed below:

  • Have 3 or more of the following conditions:
    • Chronic heart failure (CHF)
    • Diabetes
    • High cholesterol
    • High blood pressure
    • HIV/AIDS
    • Rheumatoid arthritis
    • Osteoporosis
    • Depression
    • Asthma
    • COPD
    • Coronary artery disease
  • AND
    Take 5 or more prescription medications covered by G.E.H.A.
  • AND
    Experience an annual spend of $5,330.
  • AND
    Are a G.E.H.A primary member.
    Medicare primary and other commercial primary members are not eligible.

What you can expect
The MTM program, administered by Outcomes Rx, is a two-part program. Reviews will be done over the phone, whenever it's convenient for you.

Comprehensive medication review (CMR)
The personalized review is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:

  • Prescription drugs
  • Over-the-counter (OTC) medicines
  • Herbal therapies
  • Dietary supplements and vitamins

To prepare, make a list of all the medications you take, including how many of each medication you take and how often you take them each day. The pharmacist will review your list, discuss it with you and offer ways to manage your conditions. If more information is needed, the pharmacist may contact your prescribing doctor. A review usually takes about 30 minutes.

After your review, you'll get a Personal Medication List and a Medication Action Plan. Your Medication Action Plan may include pharmacist suggestions identified during the review to discuss with your provider during your next appointment.

Targeted medication review (TMR)
Every few months, the MTM program reviews your prescription claims to ensure no new issues need attention. If the review identifies any issues, we may contact your doctor. As always, your provider will decide whether to consider any suggestions. Your prescription drugs will not change unless you and your doctor decide to change them.

Get started
If you're eligible for MTM, you're automatically enrolled. You'll get a letter or phone call letting you know how to schedule an appointment or opt out of the program. The MTM program is offered to members who qualify at no extra cost. It's not considered a benefit.

Opting out
This service is voluntary and you are not required to participate. Your prescription drug coverage will not change if you take part in the MTM program. If you have questions, or do not want to take part in the program, please call 1-844-635-3406.