Quality Initiatives and Medication Therapy Management Program (MTM) 

Global Health is committed to providing the highest quality services. To this end, the Pharmacy Department has been developing initiatives to improve the quality of life of our members. Some initiatives have the objective of promoting the proper use of medications to manage different health conditions such as osteoporosis, rheumatoid arthritis, asthma, and cardiovascular diseases, among others. Also, to promote the proper management and control of diabetes, hypertension, and high cholesterol, we have initiatives aimed at improving adherence to the medications used to treat these health conditions. We also have the Medication Therapy Management Program (MTM), which is described below: 

1. What is the Medication Therapy Management (MTM) program?

The Medication Therapy Management (MTM) program is a service whose purpose is to optimize therapeutic outcomes by improving medication use and reducing adverse effects. A trained and licensed clinical health care provider (pharmacist, nurse, or physician) will contact the participant member and your physician "if necessary" to resolve any medication-related problem and help you get better results. This program is not part of your plan benefits package. 

2. How members are eligible for the MTM Program?

The members are selected in a quarterly basis according to clinical information and pharmacy claims. The member must meet one of the following two groups (1) and/or (2) criteria: 

1)  A) Have three chronic conditions. These chronic conditions are: 

• • • • Hypertension 

• • • • Chronic congestive heart failure (CHF) 

• • • • Diabetes 

• • • • Dyslipidemia 

• • • • Respiratory disease (including asthma, chronic obstructive pulmonary disease (COPD), and chronic lung disorders 

• • • • Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis) 

• • • • End-stage renal disease (ESRD) 

• • • • Mental health (including depression, schizophrenia, bipolar disorder, and chronic/disabling mental health conditions) 

• • • • Human immunodeficiency virus /acquired immunodeficiency syndrome (HIV/AIDS)
         
      • Alzheimer’s disease

B) Must be using multiple Part D medications; and the member must incur in an average expense of 1,623 in cost for eight (8) generic drugs.

2) Are at-risk beneficiaries under a Drug Management Program (DMP) 

3. What are the services of the MTM Program?

• • Annual comprehensive review of your medications (CMR), including over-the-counter drugs, vitamins, dietary supplements, and herbal therapies. 

• • Help you understand how to take your medications and answer any questions you may have about your medications. 

• • Evaluate the risk of potential drug interactions. 

• • Ensure you are not experiencing any side effects to your medications. 

• • Advise about more cost-effective medication alternatives. 

• • Reach out to your healthcare provider when a potential medication related problem is identified. 

• • Provide information on how to manage your health condition. 

• • Quarterly targeted medication reviews (TMRs) with follow-up interventions when necessary. 

• • Provide information about the safe disposal of prescription drugs that are controlled substances, including opioids, drug take back programs, in-home disposal, and cost-effective means to safely dispose of such drugs, including the location of two (2) or more drug take back sites that are available in the community where you resides. 

• • A drug take-back site is the best way to safely dispose of medications. To find drug take back sites near you, click here and enter your location.

4. Is there a cost for members to participate in the MTM Program?

No, the MTM Program is free to eligible members. 

5. How can a member enroll in the MTM Program?

Global Health will identify eligible members to the MTM Program and notify them that they meet the program’s requirements through a welcome letter or a phone call. However, if you are interested in knowing if you meet the established requirements, you may contact us at Global Health Pharmacy Clinical Department at 787-945-1248 or 787-758-2500 extensions 5318,4254, 5718 and 2163. 

6. Are members required to participate?

No, this is a voluntary program. The MTM will have a program from which you may disenroll if you wish. The member is considered enrolled in the MTM program once the member has been identified. Once in the program, members continue to be enrolled throughout the entire calendar year unless the member requests disenrollment from the program. Members may request to disenroll from the program by verbal or written request at any time. 

7. How often will a member receive calls from the clinical health care provider?

A licensed pharmacist, nurse, or physician will contact members to conduct the comprehensive review of their medications minimum once a year and answer any questions or concerns they may have about the medications they take. Targeted medication reviews will be conducted at least quarterly. If specific or potential medication-related problems are found or the clinical health care provider needs to contact the member’s physician, follow-up calls may be scheduled more often as needed. 

8. How can a member access the MTM program documents?

The member will receive the documents of the medication review with the information collected by the licensed health care provider (pharmacist, nurse, or physician) through mail. The mailing will be done within 14 days from the date the medication review was completed. You can access a sample of the documents that will be used in the intervention by clicking on the following links: 

• 1. Recommended To Do List 
  2. How to Safely Dispose of Unused Prescription Medications 
  3. Medication List 

9. How does a member reach the licensed clinical health care provider (pharmacist, nurse, or physician) if they have questions about the MTM Program interventions?

Once the first intervention is made, the pharmacist, nurse, or physician will include in the medication review documents the phone numbers and the hours of service available in case you have questions or need to talk with these health care professionals. 

Medication Therapy Management Program

The GlobalHealth Medication Therapy Management (MTM) Program is all about you and your health. The MTM Program helps you get the most out of your medications by:

• Preventing or reducing drug-related risks
• Supporting good lifestyle habits
• Providing information for safe medication disposal options

Who qualifies for the MTM Program? 

You will be enrolled in the GlobalHealth MTM Program if you meet one of the following: 

1. Have coverage limitation(s) in place for medication(s) with a high risk for dependence and/or abuse, or 
2. Meet the following criteria: 

• You 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/AIDS 
• You take eight or more routine medications covered by your plan
• You are likely to spend more than $5,330 in Part D prescription drug costs in 2024 

Your participation in the MTM Program is voluntary and does not affect your coverage. This is not a plan benefit and is open only to those who qualify. There is no extra cost to you for the MTM Program. 

How will I know if I qualify for the MTM Program? 

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

What services are included in the MTM Program? 

In the MTM Program, you will receive the following services from a health care provider: 

• Comprehensive medication review 
• Targeted medication review 

What is a comprehensive 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. During the review, you may ask any questions about your medications or health conditions. The health care provider may offer ways to help you manage your health and get the most out of your medications. If more information is needed, the health care provider may contact your prescriber. 

After your review, you will receive a summary of what was 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 and/or caregivers 
• Here is a blank copy of the Personal Medication List for tracking your medications 

Who will contact me about completing the review? 

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 over the phone. When they call, you can schedule your review at a time that is best for you. 

• Trusted MTM Program partners: . You may receive a call from the CVS Caremark Pharmacist Review Team or the Outcomes Patient Engagement Team to complete this service.

Why is this review important? 

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 

How do I benefit from talking with a health care provider? 

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

• Understand how to safely take your medications 
• 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 for your records and to share with your prescribers and/or caregivers 

What is a targeted medication review? 

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 suggestions. Your prescription drugs will not change unless you and your prescriber decide to change them. We may also contact you by mail or phone with suggestions about your medications. 

How can I get more information about the MTM Program? 

Please contact us if you would like more information about the GlobalHealth MTM Program or if you do not want to participate. Our number is 1-844-635-3406, Monday – Friday, 8AM – 6PM CST (TTY users, call 711).  

How do I safely dispose of medications I don’t need? 

The GlobalHealth MTM Program is dedicated to providing you with information about safe medication disposal. Medications that are safe for you may not be safe for someone else. Unneeded medications should be disposed of as soon as possible. You can discard your unneeded medications through a local safe disposal program or at home for some medications. 

• Locating a community safe drug disposal site
  A drug take-back site is the best way to safely dispose of medications. To find drug take back sites near you, visit the website below and enter your location: https://apps2.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e2s1
  
  Some pharmacies and police stations offer on-site drop-off boxes, mail-back programs, and other ways for safe disposal. Call your pharmacy or local police department (non-emergency number) for disposal options near you. 

• Mailing medications to accepting drug disposal sites 
  Medications may be mailed to authorized sites using approved packages. Information on mail-back sites can be found at www.deatakeback.com. 

• Safe at-home medication disposal
  You can safely dispose of many medications through the trash or by flushing them down the toilet. Visit the following website first to learn what medications are safe to dispose of at home: https://www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html 

steps for medication disposal in the trash:

• Remove medication labels to protect your personal information 
• Mix medications with undesirable substances, such as dirt or used coffee grounds 
• Place mixture in a sealed container, such as an empty margarine tub