CareAdvantage Dual Eligible Special Needs Plan (D-SNP) 2023
Medication Therapy Management
The Medication Therapy Management (MTM) Program is an additional service that is available for free to eligible CareAdvantage members with certain medical conditions. This service is provided through Health Plan of San Mateo’s vendor, SinfoniaRx. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems. Enrollment is voluntary and does not affect Medicare coverage for drugs covered under Medicare. The program's benefits include:
Targeted Medication Review (TMR)
At least quarterly, we will review all your prescription medications and contact you and/or your doctor by phone or mail if we detect a potential problem.
Comprehensive Medication Review (CMR)
At least once a year, you get a free review and 30-minute discussion of all of your medications (including over-the-counter products) by a pharmacist or other health professional. The CMR:
- Is a confidential discussion either by telephone or in person at your provider’s office, pharmacy or long-term care facility. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider.
- Identifies if you are taking duplicate medicines and any potential problems with taking medicines together.
- Can help you organize your medications, making it easier to know what to take when.
- Is provided through pharmacies operated by Tabula Rasa HealthCare.
Following the CMR, you get a written summary of the discussion that includes:
- A Recommended To-Do List with steps you can take to get the best results from your medications.
- A Personal Medication List to help you keep track of your medications and how to use them correctly.
The MTM program is not considered a benefit and is required by the Centers for Medicare and Medicaid Services (CMS) which (in part) sets the criteria for participation. SinfoniaRx identifies eligible program participants on a weekly basis. They then send letters to eligible individuals inviting them to join the program. If you take multiple medications for more than one chronic health condition, you may be eligible for the MTM program. Please contact the CareAdvantage Unit to learn more.
To take part in the MTM program, you must meet all of the following three criteria:
- Take at least eight drugs covered by Medicare Part D.
- Have expected Medicare Part D drug costs greater than $4,935 per year.
- Have a diagnosis of three of the following medical conditions:
- Rheumatoid Arthritis
- Chronic Heart Failure (CHF)
- End-Stage Renal Disease (ESRD)
- Cardiovascular Disorders
- Chronic Obstructive Pulmonary Disease (COPD)
- Chronic Noncancer Pain
CareAdvantage Dual Eligible Special Needs Plan (D-SNP) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Limitations and restrictions may apply. For more information, call the CareAdvantage Unit or read the CareAdvantage 2023 Member Handbook.
Benefits and co-pays may change on January 1 of each year.
If you speak other languages other than English, language assistance services, free of charge, are available to you. Call 1-866-880-0606 (TTY: 1-800-735-2929 or dial 7-1-1). ( Download this statement in multiple languages.)
Page updated October 1, 2022