藥物治療管理 (MTM) 計劃

如果您符合以下條件之一，您將自動參加該計劃：

1. 對具有高依賴性或高濫用風險的藥物有承保限制，或者
2. 具有三種或三種以上此類情況：

• 哮喘
• 慢性心力衰竭 (CHF)
• 慢性阻塞性肺病 (COPD)
• 糖尿病
• 血脂異常
• 高血壓
• 慢性酒精和藥物依賴
• 人類免疫缺陷病毒/愛滋病 (HIV/AID)

3. 您服用八種或八種以上計劃承保的維持藥物

4. 您可能在 2024 年花費超過 5,330 美元的處方藥費用。

如果您符合資格，我們將給您寄一封信。請參閱信函樣本。 您也可能會接到電話，為您安排一對一的藥物審查。

作為藥物治療計劃的一部分，您將獲得藥物治療審查、個人藥物記錄、與藥物治療相關的行動計劃、干預或轉診以及文件記錄和後續追蹤。 藥物治療審查包括兩個部分：

• 綜合藥物審查
• 靶向藥物審查

綜合藥物審查由健康護理提供者親自或透過電話完成。 該審查包括對您所有藥物的討論：

• 处方
• 非處方藥 (OTC)
• 草藥療法
• 膳食補充劑

該審查通常只需 20 分鐘或更短時間即可完成。 在審查過程中，您可以提出有關藥物或健康狀況的問題。 健康護理提供者可能會提供一些方法來協助您管理健康並充分利用藥物。 如果需要更多資訊，健康護理提供者可能會聯絡您的處方醫生。

審查結束後，健康護理提供者會向您提供一份討論內容摘要。 摘要將包括以下內容：

建議的待辦事項清單。您的待辦事項清單可能包括供您和處方醫生在下次就診時討論的建議。

藥物清單。 這是一份在您審查期間討論過的所有藥物的清單。 您可以保留這份清單，並與處方醫生或護理人員分享。

靶向藥物審查由醫療服務提供者完成，他們至少每三個月審查一次您的藥物。 透過這種審查，我們會郵寄、傳真或致電給您的處方醫生，為您提供可能更安全或療效更好的處方藥建議。 一如既往，您的處方醫生將決定是否考慮我們的建議。 只有當您和您的處方醫生決定更換處方藥時，您的處方藥才會發生變化。 我們也可能透過郵件或電話與您聯絡，為您提供藥物建議。

不同的處方醫生可能在不瞭解您服用的所有藥物的情況下為您開具處方。  因此，MTM 計劃的健康護理提供者將：

• 審查您服用的所有藥物
• 討論藥物之間可能產生的相互影響
• 確定藥物的任何副作用
• 協助您降低處方藥費用

您可能會接到您最近配過一種或多種處方藥的藥房打來的電話。 您可以選擇親自或透過電話完成審查。

健康護理提供者也可能會致電給您以完成審查。 當他們打來電話時，您可以安排在最適合您的時間進行審查。

值得信賴的 MTM 計劃合作夥伴： CVS Caremark 藥劑師審查小組或結果病患參與小組

透過與健康護理提供者一起完成藥物審查，您將：

• 瞭解如何安全服藥
• 獲得有關您的藥物或健康狀況的任何問題的答案
• 瞭解協助您節省藥費的方法
• 收到一份建議待辦事項清單和藥物清單，以便儲存並與處方醫生或護理人員分享

If you meet one of the following criteria, you will be automatically enrolled:

1. Have coverage limitation(s) in place for medication(s) with a high risk for dependence or abuse or
2. Have three or more of these conditions:

• Asthma
• Chronic heart failure (CHF)
• Chronic obstructive pulmonary disease (COPD)
• Diabetes
• Dyslipidemia
• Hypertension
• Chronic alcohol & drug dependence
• HIV/AID

3. You take eight or more maintenance medications covered by your plan

4. You are likely to spend more than $ 5,330 in prescription drug costs in 2024.

If you qualify, we will mail you a letter. See Letter Sample. You may also receive a call to set up your one-on-one medication review.

As part of the Medication Therapy Program, you will receive a medication therapy review, a personal medication record, a medication-related action plan, an intervention or referral, and documentation and follow-up. The medication therapy review consists of two parts:

• Comprehensive medication review
• Targeted medication review

The comprehensive medication review is completed with a health care provider in person or over the phone. This review is a discussion that includes all your medications:

• Prescriptions
• Over-the-counter (OTC)
• Herbal therapies
• Dietary supplements

This review usually takes 20 minutes or less to complete. You may ask questions about your medications or health conditions during the review. The health care provider may offer ways to help you manage your health and get the most out of your medications. The health care provider may contact your prescriber if more information is needed.

At the end of the review, the health care provider will provide you with a summary of what you discussed. The summary will include the following:

Recommended To-Do List. Your to-do list may include suggestions for you and your prescriber to discuss during your next visit.

Medication List. This is a list of all the medications discussed during your review. You can keep this list and share it with your prescribers or caregivers.

The targeted medication review is completed by a health care provider who reviews your medications at least once every three months. With this review, we mail, fax, or call your prescriber with suggestions about prescription drugs that may be safer or work better for you. As always, your prescriber will decide whether to consider our recommendations. Your prescription drugs will only change if you and your prescriber decide to change them. We may also contact you by mail or phone with medication suggestions.

Different prescribers may write prescriptions for you without knowing all the medications you take.  For that reason, the MTM Program health care provider will:

• Review all your medications
• Discuss how your medications may affect each other
• Identify any side effects from your medications
• Help you reduce your prescription drug costs

You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You can choose to complete the review in person or over the phone.

A health care provider may also call you to complete your review. When they call, you can schedule your review at a time that is best for you.

Trusted MTM Program partners: CVS Caremark Pharmacist Review Team or the Outcomes Patient Engagement Team

By completing the medication review with a health care provider, you will:

• Understand how to take your medications safely
• Get answers to any questions you may have about your medications or health conditions
• Review ways to help you save money on your drug costs
• Receive a Recommended To-Do List and Medication List to keep and share with your prescribers or caregivers