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Medication Therapy Management

The Horizon Blue Cross Blue Shield of New Jersey’s Medication Therapy Management Program (MTM program) is part of our Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage. The Centers for Medicare and Medicaid Services (also called CMS) requires all Medicare Part D sponsors to offer an MTM program to eligible members.

Information by plan type

To be eligible for Horizon Blue Cross Blue Shield of New Jersey’s MTM plan, you must:

  1. Have at least three chronic conditions from the list:
    • Alzheimer’s/Dementia
    • Asthma
    • Behavioral health disorders
    • Chronic pain
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Diabetes
    • Dyslipidemia
    • End-stage renal disease
    • Heart Failure
    • Hepatitis C
    • Hypertension
    • Multiple Sclerosis
    • Osteoarthritis
    • Osteoporosis
    • Rheumatoid Arthritis (RA)
  2. Take six or more Part D covered drugs to treat your chronic conditions.
  3. Have an expected cost of at least $4,255 a year or $1,063.75 per quarter for your Part D covered drugs in 2020.

How does the MTM program benefit me?

The MTM program was designed with your health as our top priority and is a service to use in addition to the conversations with your doctor and pharmacists. The aim of the MTM program is to work with you and your doctor to help you achieve and maintain the safest and most effective medication therapy for you. The program helps you, your doctor, and your health care team strengthen the management of medications by:

  1. Empowering you to take an active role in your health care experiences
  2. Providing you with education material to help you achieve and maintain your best level of health:
    • Fact sheets on your chronic conditions.
    • Tips and tricks.
    • Information about nutrition and physical activity.
    • Recommended goals.
  3. Providing you with the opportunity to speak with a live pharmacist.
  4. Performing targeted reviews every quarter to ensure there are no safety concerns, missed opportunities or issues such as:

    If there are any safety concerns, missed opportunities or issues, we will notify you, your doctor and/or your health care team by mail or telephone.

    • Taking similar medications.
    • Gaps in therapy.
    • Taking medicines with in U.S. Food and Drug Administration (FDA) guidelines.
    • Interactions between your medications.
  5. Providing you, your doctor and your health care team with current information on your medications and chronic conditions.

Our team of trusted pharmacists may reach out to you or your doctor to alert you to any gaps in therapy or safety concerns. He or she will work with you to schedule an appointment to speak with one of our trusted pharmacists on the telephone to participate in a Comprehensive Medication Review.

What is a Comprehensive Medication Review?

CMS requires all MTM programs to complete a Comprehensive Medication Review with each member. A Comprehensive Medication Review (also called a CMR) is a review of all your prescription medications, over-the-counter medications (medications such as aspirin or heartburn pills), vitamins and herbal supplements with a trusted pharmacist over the telephone.
  1. A CMR can help you better understand your medications by explaining how they work best, what to watch out for and how to save on costs.
  2. During a CMR you will receive personal attention from one of our trusted pharmacists without being rushed.
  3. Along with reviewing your medications, the pharmacist will answer your medication questions.
  4. The pharmacist can also help you with general answers to questions you have about your health.
  5. A written summary of the discussion, including a personal medication list with counseling points, will be sent to you for your personal records within 14 days of the review.
  6. A copy of the written summary will also be sent to up to three of your doctors so that you and your doctors can address your health issues together.

How much will the MTM program cost me?

The MTM program and its services are provided to you for no additional cost.

How will the MTM program affect my plan coverage?

The MTM program is not considered part of your plan benefits that you pay for and will not affect your coverage in any way. The MTM program is a free health service program offered to eligible members.

How do I enroll in the MTM program?

You do not need to do anything to enroll in the MTM program. We will automatically enroll you and send you a welcome letter if you are eligible for the program. Along with the welcome letter, you will receive a short form to fill out and return to us in the postage paid envelope to help us schedule your CMR. You may also be called to schedule a CMR or you can call us directly to schedule a CMR or to speak with a pharmacist.

I have more questions…

To speak with one of Horizon Blue Cross Blue Shield of New Jersey’s MTM team members, call 1-888-706-2820, Monday through Friday, between 9 a.m. and 5:00 p.m., ET. Due to high call volume, you may get the MTM voicemail. Please leave your name and a call back number and your call will be returned promptly. Members who have hearing or speech difficulties should call our TTY line at 711, during the same hours.

You can write to us:

Horizon BCBSNJ MTM Program
PP-12Q
3 Penn Plaza East
Newark, NJ 07105

Downloads

Pdf ImagePersonal Medication List

To be eligible for Horizon Blue Cross Blue Shield of New Jersey’s MTM plan, you must:

  1. Have at least three chronic conditions from the list:
    • Alzheimer’s/Dementia
    • Asthma
    • Behavioral health disorders
    • Chronic pain
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Diabetes
    • Dyslipidemia
    • End-stage renal disease
    • Heart Failure
    • Hepatitis C
    • Hypertension
    • Multiple Sclerosis
    • Osteoarthritis
    • Osteoporosis
    • Rheumatoid Arthritis (RA)
  2. Take eight or more Part D covered drugs to treat your chronic conditions.
  3. Have an expected cost of at least $4,255 a year or $1,063.75 per quarter for your Part D covered drugs in 2020.

How does the MTM program benefit me?

The MTM program was designed with your health as our top priority and is a service to use in addition to the conversations with your doctor and pharmacists. The aim of the MTM program is to work with you and your doctor to help you achieve and maintain the safest and most effective medication therapy for you. The program helps you, your doctor, and your health care team strengthen the management of medications by:

  1. Empowering you to take an active role in your health care experiences
  2. Providing you with education material to help you achieve and maintain your best level of health:
    • Fact sheets on your chronic conditions.
    • Tips and tricks.
    • Information about nutrition and physical activity.
    • Recommended goals.
  3. Providing you with the opportunity to speak with a live pharmacist.
  4. Performing targeted reviews every quarter to ensure there are no safety concerns, missed opportunities or issues such as:

    If there are any safety concerns, missed opportunities or issues, we will notify you, your doctor and/or your health care team by mail or telephone.

    • Taking similar medications.
    • Gaps in therapy.
    • Taking medicines with in U.S. Food and Drug Administration (FDA) guidelines.
    • Interactions between your medications.
  5. Providing you, your doctor and your health care team with current information on your medications and chronic conditions.

Our team of trusted pharmacists may reach out to you or your doctor to alert you to any gaps in therapy or safety concerns. He or she will work with you to schedule an appointment to speak with one of our trusted pharmacists on the telephone to participate in a Comprehensive Medication Review.

What is a Comprehensive Medication Review?

CMS requires all MTM programs to complete a Comprehensive Medication Review with each member. A Comprehensive Medication Review (also called a CMR) is a review of all your prescription medications, over-the-counter medications (medications such as aspirin or heartburn pills), vitamins and herbal supplements with a trusted pharmacist over the telephone.
  1. A CMR can help you better understand your medications by explaining how they work best and what to watch out for.
  2. During a CMR you will receive personal attention from one of our trusted pharmacists without being rushed.
  3. Along with reviewing your medications, the pharmacist will answer your medication questions.
  4. The pharmacist can also help you with general answers to questions you have about your health.
  5. A written summary of the discussion, including a personal medication list with counseling points, will be sent to you for your personal records within 14 days of the review.
  6. A copy of the written summary will also be sent to up to three of your doctors so that you and your doctors can address your health issues together.

How much will the MTM program cost me?

The MTM program and its services are provided to you for no cost.

How will the MTM program affect my plan coverage?

The MTM program is not considered part of your plan benefits and will not affect your coverage in any way. The MTM program is a free health service program offered to eligible members.

How do I enroll in the MTM program?

You do not need to do anything to enroll in the MTM program. We will automatically enroll you and send you a welcome letter if you are eligible for the program. Along with the welcome letter, you will receive a short form to fill out and return to us in the postage paid envelope to help us schedule your CMR. You may also be called to schedule a CMR or you can call us directly to schedule a CMR or to speak with a pharmacist.

I have more questions…

To speak with one of Horizon Blue Cross Blue Shield of New Jersey’s MTM team members, call 1-888-706-2820, Monday through Friday, between 9 a.m. and 5:00 p.m., ET. Due to high call volume, you may get the MTM voicemail. Please leave your name and a call back number and your call will be returned promptly. Members who have hearing or speech difficulties should call our TTY line at 711, during the same hours.

You can write to us:

Horizon BCBSNJ MTM Program
PP-12Q
3 Penn Plaza East
Newark, NJ 07105

Downloads

Pdf ImagePersonal Medication List

To be eligible for Horizon Blue Cross Blue Shield of New Jersey’s MTM plan, you must:

  1. Have at least three chronic conditions from the list:
    • Alzheimer’s/Dementia
    • Asthma
    • Behavioral health disorders
    • Chronic pain
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Diabetes
    • Dyslipidemia
    • End-stage renal disease
    • Heart Failure
    • Hepatitis C
    • Hypertension
    • Multiple Sclerosis
    • Osteoarthritis
    • Osteoporosis
    • Rheumatoid Arthritis (RA)
  2. Take eight or more Part D covered drugs to treat your chronic conditions.
  3. Have an expected cost of at least $4,255 a year or $1,063.75 per quarter for your Part D covered drugs in 2020.

How does the MTM program benefit me?

The MTM program was designed with your health as our top priority and is a service to use in addition to the conversations with your doctor and pharmacists. The aim of the MTM program is to work with you and your doctor to help you achieve and maintain the safest and most effective medication therapy for you. The program helps you, your doctor, and your health care team strengthen the management of medications by:

  1. Empowering you to take an active role in your health care experiences
  2. Providing you with education material to help you achieve and maintain your best level of health:
    • Fact sheets on your chronic conditions.
    • Tips and tricks.
    • Information about nutrition and physical activity.
    • Recommended goals.
  3. Providing you with the opportunity to speak with a live pharmacist.
  4. Performing targeted reviews every quarter to ensure there are no safety concerns, missed opportunities or issues such as:

    If there are any safety concerns, missed opportunities or issues, we will notify you, your doctor and/or your health care team by mail or telephone.

    • Taking similar medications.
    • Gaps in therapy.
    • Taking medicines with in U.S. Food and Drug Administration (FDA) guidelines.
    • Interactions between your medications.
  5. Providing you, your doctor and your health care team with current information on your medications and chronic conditions.

Our team of trusted pharmacists may reach out to you or your doctor to alert you to any gaps in therapy or safety concerns. He or she will work with you to schedule an appointment to speak with one of our trusted pharmacists on the telephone to participate in a Comprehensive Medication Review.

What is a Comprehensive Medication Review?

CMS requires all MTM programs to complete a Comprehensive Medication Review with each member. A Comprehensive Medication Review (also called a CMR) is a review of all your prescription medications, over-the-counter medications (medications such as aspirin or heartburn pills), vitamins and herbal supplements with a trusted pharmacist over the telephone.
  1. A CMR can help you better understand your medications by explaining how they work best and what to watch out for.
  2. During a CMR you will receive personal attention from one of our trusted pharmacists without being rushed.
  3. Along with reviewing your medications, the pharmacist will answer your medication questions.
  4. The pharmacist can also help you with general answers to questions you have about your health.
  5. A written summary of the discussion, including a personal medication list with counseling points, will be sent to you for your personal records within 14 days of the review.
  6. A copy of the written summary will also be sent to up to three of your doctors so that you and your doctors can address your health issues together.

How much will the MTM program cost me?

The MTM program and its services are provided to you for no cost.

How will the MTM program affect my plan coverage?

The MTM program is not considered part of your plan benefits and will not affect your coverage in any way. The MTM program is a free health service program offered to eligible members.

How do I enroll in the MTM program?

You do not need to do anything to enroll in the MTM program. We will automatically enroll you and send you a welcome letter if you are eligible for the program. Along with the welcome letter, you will receive a short form to fill out and return to us in the postage paid envelope to help us schedule your CMR. You may also be called to schedule a CMR or you can call us directly to schedule a CMR or to speak with a pharmacist.

I have more questions…

To speak with one of Horizon Blue Cross Blue Shield of New Jersey’s MTM team members, call 1-888-706-2820, Monday through Friday, between 9 a.m. and 5:00 p.m., ET. Due to high call volume, you may get the MTM voicemail. Please leave your name and a call back number and your call will be returned promptly. Members who have hearing or speech difficulties should call our TTY line at 711, during the same hours.

You can write to us:

Horizon BCBSNJ MTM Program
PP-12Q
3 Penn Plaza East
Newark, NJ 07105

Downloads

Pdf ImagePersonal Medication List

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