MCS 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:
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..
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:
A) Have three chronic conditions. These chronic conditions are:
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
Are at-risk beneficiaries under a Drug Management Program (DMP)
No, the MTM Program is free to eligible members.
MCS Classicare 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 MCS Pharmacy Clinical Department at 787-945-1248 or 787-758-2500 extensions 5318,4254 and 2163.
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.
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.
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:
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 professional.