Latest News

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, or 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.

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. You can disenroll at any time by calling our Pharmacy Clinical Operations Department at 1-866-778-6073 Monday through Friday between 8 a.m. and 4:30 p.m. TTY users should call 1-800-361-2629. 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.
  • An annual Comprehensive Medication Review (CMR). This is a 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. Click here to see a blank copy of the personal medication list.

2017
You must meet the following criteria to be eligible for UPMC for Life's MTM program.

  • Have three 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 $3,919.00 for all covered Part D drugs. (UPMC estimates that members whose drug costs equal or exceed $979.75 in a 90-day period will have an annual drug cost of at least $3,919.00.)

2018
You must meet the following criteria to be eligible for UPMC for Life's MTM program.

  • Have three 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 $3,967.00 for all covered Part D drugs. (UPMC estimates that members whose drug costs equal or exceed $991.75 in a 90-day period will have an annual drug cost of at least $3,967.00.)

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 pharmacist 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 our Pharmacy Clinical Operations Department at 1-866-778-6073 Monday through Friday between 8 a.m. and 4:30 p.m. TTY users should call 1-800-361-2629.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Out-of-network/non-contracted providers are under no obligation to treat UPMC for Life members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Other physicians/providers are available in the UPMC for Life network.

The UPMC for Life Medicare Advantage HMO and PPO plans are available to persons entitled to Medicare Part A and enrolled in Part B. You must continue to pay your Medicare Part B premium, reside in the service area, and not have end-stage renal disease (ESRD).

This information is available for free in other languages. Please call our customer service number at 1-877-539-3080 (TTY: 1-800-361-2629). We are available October 1 through February 14, seven days a week from 8 a.m. to 8 p.m. From February 15 through September 30, we are available Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m.

UPMC for Life has a contract with Medicare to provide HMO and PPO plans. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., and UPMC Health Benefits Inc.

The Silver&Fit program is a product of American Specialty Health Fitness, Inc., (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). All programs and services are not available in all areas. Silver&Fit® is a federally registered trademark of ASH and used with permission herein.

*Our hours of operation change twice a year.

You can call us:

October 1 through February 14:
seven days a week from 8 a.m. to 8 p.m.

February 15 through September 30:
Monday through Friday: 8 a.m. to 8 p.m.
Saturday: 8 a.m. to 3 p.m.

Y0069_18_1122 Approved

Last Updated: 10/01/2017

Copyright 2018.

UPMC Health Plan, Inc.

Download Our Mobile App

Apple Store Google Play

Translation services available: