California PHP

The Medication Therapy Management Program (MTMP) is a feature of PHP (HMO SNP). MTMP can help people who take multiple prescription drugs, have chronic illnesses, and/or expect to spend a significant amount of money on prescription drugs each year.

Who might be eligible?

Members will be enrolled in PHP’s MTM program if they meet one of the following:

1. Meet specific eligibility criteria (must meet each criterion):
   • The member has a minimum of three (3) disease states:
     • • Alzheimer’s disease
       • Bone disease/arthritis/osteoporosis
       • Chronic heart failure (CHF)
       • Diabetes
       • Dyslipidemia
       • End-stage renal disease (ESRD)
       • HIV/AIDS
       • Hypertension
       • Chronic/disabling mental health conditions
       • Respiratory disease – asthma, chronic obstructive pulmonary disease (COPD), and chronic lung disorders
   • The member is prescribed a minimum of eight (8) different Part D maintenance medications.
   • Drug costs of $405.75 (one-fourth of $1,623) for the previous three months are likely to be incurred.
2. Are determined to be an at-risk beneficiary (ARB) due to opioid use and are part of our Drug Management Program (DMP).

Enrolled members will receive a yearly comprehensive medication review (CMR), a quarterly targeted medication review (TMR), and annual safe disposal information. Here are some details on MTM services:

Comprehensive Medication Review (CMR):
Every year you qualify, an AHF Clinical Pharmacist will call you to complete your annual comprehensive medication review (CMR). The pharmacist will go over all your medicines (prescription, over the counter, and supplements) to make sure you have the right ones for your condition(s) and that you avoid drug interactions. The CMR may take about 30 minutes for the pharmacist to review all this information with you.

Once your CMR is done, you will get your Medication Action Plan (MAP) and Personal Medication List (PML) by mail within 14 days.

Targeted Medication Review (TMR):
The clinical pharmacy team will also complete a targeted medication review (TMR) at least quarterly throughout the year by reviewing for potential issues with your medicines. You may get TMR recommendations by mail and your primary care provider may receive recommendations by fax—if the clinical pharmacy team deems it necessary.

Safe Disposal Information:
Annually, you will also receive information on the safe disposal of prescription medications that are controlled substances.

Additional Information:

You can also download a blank copy of the Personal Medication List that you may use to track your medications.

If you choose to not participate in the MTMP, please MTMP opt out form, complete and return it to us at the address shown on the form. You can also call Member Services and tell us that you do not want to participate.

For more information about the MTMP, please contact Member Services.

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.