Medication Therapy Management

How does UPMC for Life help make sure I’m safe on my prescription medications?

One of UPMC for Life's main goals when creating its drug formulary (the list of medications we cover) is to keep our members safe.

An important way we keep members safe is through our drug utilization review.

We have gathered data over the years, and that data now helps us recognize harmful drug-drug interactions. We have safeguards built right into our pharmacy system that reduce the chances of our members experiencing a harmful drug interaction.

UPMC for Life will send an electronic warning to your pharmacist if he or she tries to fill a prescription for a drug that could interact adversely with another medication that you are already taking. This service has been available to our members for some time, and it is constantly reviewed as new drugs come to market and as new, potentially harmful drug combinations are discovered.

Drug utilization is also reviewed after prescriptions for medications have been filled. Our clinical pharmacy team reviews, reports, and identifies members who are at risk for adverse drug events. The team will contact the members' doctors to discuss potential problems uncovered during the review.

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How does UPMC for Life help members who take many medications?

If you have more than one long-term health condition, take many medications every day, and have an expensive drug therapy regimen, you might feel like you could use some extra help managing your medications.

UPMC Health Plan’s Medication Therapy Management (MTM) program is available at no cost to you. The program is administered by a team of health care professionals that includes pharmacists, registered nurses, and social workers.

If you meet the criteria below, you are automatically enrolled in the program. You don’t have to do anything. If you do not want to participate in this program, please call 1-844-870-2224 (TTY: 711) Monday through Friday from 9 a.m. to 5 p.m. But the program is very helpful. It includes:

• Monthly medication reviews to look for problems, such as drug interactions, duplications in drug therapy, and gaps in care (care you should have gotten but did not).
• Letters and phone calls to prescribers to inform them of potential drug-related issues.
• You may receive a letter or a brief 5- to 10-minute phone call from a health care professional following up about important medication(s) to ensure you are not experiencing any problems or concerns.
• An annual Comprehensive Medication Review (CMR). This is an approximately 30-minute phone call between you and a pharmacist. The pharmacist will talk to you about your medications and listen to any concerns you have about them. After the CMR, you will receive a medication action plan and personal medication list in the mail. These materials are sent out within a week of the CMR review. View a blank copy of the personal medication list.

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Who is eligible for UPMC for Life's medication management program?

2020
You must meet the following criteria to be eligible for UPMC for Life's MTM program.

• Have 3 or more of the following 17 chronic diseases: Alzheimer’s disease, asthma, cardiovascular disease, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, dementia, dyslipidemia, end-stage renal disease (ESRD), HIV/AIDS, hypertension, multiple sclerosis, osteoporosis, transplant, rheumatoid arthritis, Parkinson's disease, schizophrenia; and must have filled eight or more chronic/maintenance Part D covered drugs within a 90-day period.
• Be likely to incur annual costs that meet or exceed $4,255 for all covered Part D drugs. (UPMC estimates that members whose drug costs equal or exceed $1063.75 in a 90-day period will have an annual drug cost of at least $4,255.)

2021
You must meet the following criteria to be eligible for UPMC for Life's MTM program.

• Have 3 or more of the following 17 chronic diseases: Alzheimer’s disease, asthma, cardiovascular disease, chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, dementia, dyslipidemia, end-stage renal disease (ESRD), HIV/AIDS, hypertension, multiple sclerosis, osteoporosis, transplant, rheumatoid arthritis, Parkinson's disease, schizophrenia; and must have filled eight or more chronic/maintenance Part D covered drugs within a 90-day period.
• Be likely to incur annual costs that meet or exceed $4,376 for all covered Part D drugs. (UPMC estimates that members whose drug costs equal or exceed $1,094 in a 90-day period will have an annual drug cost of at least $4,376.)

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If you are eligible, you will receive a letter that:

• Notifies you of your enrollment in the program.
• Provides instructions on how to schedule a CMR.
• Provides instructions on how to opt out of the MTM program.

Members who do not respond to the letter will receive an automated phone call and/or a call from a pharmacy representative to schedule a CMR. Members in the MTM program may also receive phone calls from a registered nurse, social worker, and/or case manager.

This program is not considered a benefit. For more information regarding UPMC for Life's Medication Therapy Management program, please call 1-844-870-2224 (TTY: 711). Representatives are available Monday through Friday from 9 a.m. to 5 p.m.