The Bright Health Medication Therapy Management (MTM) program.


Basics of the MTM program.

The Bright Health Medication Therapy Management program helps you get the greatest health benefit from your medications by:

  • Preventing or reducing drug-related risks
  • Increasing your awareness
  • Supporting good habits

Who qualifies for the program?

We will automatically enroll you in the Bright Health program at no cost to you if all three conditions apply:

  1. You take eight or more Medicare Part D covered maintenance drugs, and
  2. You have three or more of these long-term health conditions:
  • Asthma
  • Chronic obstructive pulmonary disease
  • Diabetes
  • Depression
  • Osteoporosis
  • Chronic heart failure
  • Cardiovascular disorders such as high blood pressure, high cholesterol or coronary artery disease, and
  1. You reach $4,044 in yearly prescription drug costs paid by you and the plan.

Your participation is voluntary, and does not affect your coverage. This program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all members.

What services are included in the program?

The program provides you with a:

  • Comprehensive medication review, and
  • Targeted medication review

Comprehensive Medication Review

The review is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:

  • Prescription drugs
  • Over-the-counter (OTC) medicines
  • Herbal therapies
  • Dietary supplements and vitamins

The pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the pharmacist may contact your prescribing doctor. The review takes about 30 minutes and is usually offered once each year — if you qualify. At the end of your discussion, the pharmacist will provide you a Personal Medication List with the medications you discussed during your review.

You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

Here is an example of the Personal Medication List  that you’ll walk through as a part of the program.

Targeted Medication Review

With this review, we mail, fax or call your doctor with suggestions about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them. We may also contact you, by mail or phone, with suggestions about your medications.

How will I know if I qualify for the program?

If you qualify, we will mail you a letter. Also, you may receive a call, inviting you to participate in this one-on-one medication review.

Who will contact me about the review?

You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You will be given the option to choose an in-person review or a phone review.

You may be contacted by a call center pharmacist to provide your review, and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.

Why is a review with a pharmacist important?

Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:

  • Discuss how your prescription drugs and OTC medications may affect each other
  • Identify any prescription drugs and OTC medications that may cause side effects and offer suggestions to help
  • Help you get the most benefit from all of your prescription drugs and OTC medications
  • Review opportunities to help you reduce your prescription drug costs

How do I benefit from talking with a pharmacist?

  • Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely
  • The pharmacy can look for ways to help you save money on your out-of-pocket prescription drug costs
  • You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with your doctors and health care providers

How can I get more information about the program?

Please contact us if you would like additional information about our program, or if you do not want to participate after being enrolled in the program. Our number is 1-844-635-3406 24 hours a day, 7 days a week. (TTY users, call 711.)

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Last Updated: Fri Nov 23 2018

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Bright Health plans are HMOs and PPOs with a Medicare contract. Our plans are issued through Bright Health Insurance Company or one of its affiliates. Enrollment in our plans depends on contract renewal.

This information is not a complete description of benefits. Call 844-667-5502 | TTY:711 for more information.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

You must continue to pay your Medicare Part B premium.

Every year, Medicare evaluates plans based on a 5-star rating system.

Medicare beneficiaries may also enroll in Bright Health Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov 

Bright Health Medicare Advantage plans are plans with a network of doctors, hospitals, pharmacies, and other providers. Out-of-network/noncontracted providers are under no obligation to treat Bright Health members, except in emergency situations.

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs.

Other providers are available in our network. Most network providers participate through our Care Partner.

Bright Advantage Special Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2021 based on a review of Bright Advantage Special Care (HMO SNP) Model of Care.

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