Medication Therapy Management Program

Blue Cross & Blue Shield of Rhode Island has partnered with ClarestHealth AI, LLC. (formerly named CSS Health) to administer our Medication Therapy Management (MTM) program. The goal of our MTM program is to ensure you are receiving the most effective medications, while also helping to reduce the risk of side effects and drug interactions as well as your out-of-pocket costs. The program is paid in full by your plan. This means that you can receive the benefits of the MTM program at no cost to you. There is no change to insurance benefits, copays, prescription coverage, or available doctors or pharmacies.

You will be automatically enrolled in the Medication Therapy Management Program if you:

  • Are taking eight (8) or more Part D-covered chronic/maintenance drugs, and
  • Have incurred one-fourth of the specified annual cost threshold ($1,623) in the previous three month and

  • Have three or more of the following chronic diseases:

    • Alzheimer's Disease
    • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
    • Chronic Congestive Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia
    • End-stage renal disease (ESRD)
    • Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
    • Hypertension
    • Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
    • Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders

    OR

  • You are enrolled in a drug management program to help better manage and safely use medications such as opioids and benzodiazepines

Blue Cross & Blue Shield of Rhode Island’s members who meet the criteria for participation will be sent an introduction letter that describes the MTM program. Specially trained pharmacists work closely with you and your doctors to solve any problems related to medicines and to help you get the best results.

As part of the program, you will receive a Comprehensive Medication Review (CMR), which is an interactive, person-to-person consultation with a pharmacist. CMRs may occur face-to-face, over the phone, or using telehealth. During the review, a licensed pharmacist reviews your medications, vitamins, herbals, and supplements. The pharmacist will identify any duplicate medications, complications, and more cost-effective alternatives. The pharmacists will also complete your Personal Medication List with you and provide you with your medication action plan, which outlines what you have talked about and what you need to do (when to take medication, how, for what etc.). You should share this plan with your doctor. The medication review takes about 30 minutes to complete. Targeted Medication Reviews are completed on a quarterly basis. As part of this review, prescription claims history is reviewed and any potential drug therapy concerns are identified and member interventions will occur as needed.

Medicare requires that MTM programs automatically enroll those who qualify through the calendar year, but participation is voluntary, and members are given the opportunity to opt out at any time. Please note that the MTM program is not considered a benefit and based on the limited eligibility criteria, not all plan members will qualify. This is a free service for eligible members.

You can take this personal medication list to your next doctor's appointment and complete it together with your doctor.

If you would like additional information or you do not wish to take part in the MTM program, please call the Medicare Concierge Team.