Clear Spring Health offers a Medication Therapy Management (MTM) Program at no additional cost for our qualified Medicare members. This program is separate from the prescription drug plans that we already offer. A team of pharmacists and doctors at our Pharmacy Benefits Manager, EnvisionRx Options, developed and maintains the program, which gives members additional support with their Part D medications.
We use criteria established by Medicare to identify eligible members. Members must be filling at least eight Part D prescription drugs per month, have had an accumulated drug costs of at least $1,063.75 in the previous quarter, and have documented illnesses in at least three of these chronic conditions:
- Diabetes
- Hypertension
- Bone Disease – Arthritis - Osteoporosis
- Alzheimer’s Disease
- Dyslipidemia
Each eligible member’s drug information is analyzed for potential drug-drug interactions, possible adverse effects of medications, or gaps in care. Every quarter, we automatically enroll qualified members in Clear Spring Health’s MTM program so they may begin receiving this extra support. Eligible MTM members will receive a letter notifying them that they have been auto-enrolled into the MTM Program.
MTM members can also receive a Comprehensive Medication Review (CMR) providing a chance to review all of your current medications with a pharmacist, nurse or other qualified healthcare professional. This 30-minute phone conversation results in a Personal Medication List (PML) and Medication Action Plan (MAP). The PML lists your current prescription medications, over-the-counter medications and dietary and herbal supplements. The MAP summarizes what was discussed in the CMR and discussion topics for you and your doctor.
Although we encourage members to take advantage of our valuable program, you can opt out. If you do not want to participate, or if you have questions, please call the EnvisionRx Options MTM Department at 1-866-342-2183 (TTY: 711) weekdays from 9 a.m. to 5 p.m. ET.