CareAdvantage Dual Eligible Special Needs Plan (D-SNP) 2024

Medication Therapy Management

The Medication Therapy Management (MTM) Program is an additional service that is available at no cost to eligible CareAdvantage members with certain medical conditions. This service is provided through Health Plan of San Mateo’s vendor, MedWatchers. 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 your medications (including over-the-counter products) by a pharmacist or other health professional. The CMR:

• Is a confidential discussion by telephone.
• 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.

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.

If a representative has reached out to you about MTM and you are interested in receiving a CMR, please call MedWatchers at the number below..

Eligibility

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. MedWatchers identifies eligible program participants on a weekly basis. If you are eligible, MedWatchers will be sending you a letter and/or will be calling you to invite you to join the program. 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:

1. Take at least eight drugs covered by Medicare Part D.
2. Have expected Medicare Part D drug costs greater than $5,330 per year.
3. Have a diagnosis of three of the following medical conditions: