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• Medication Therapy Management

Medication Therapy Management

It is the policy of Florida Health Care Plans (FHCP) to operate and maintain a Medication Therapy Management Program (MTMP) in compliance with Medicare Part D guidelines. This program is a collaborative program between the medical and pharmacy departments of FHCP using the present internal staff. The Health Resource Delivery Complex Patient Care System is part of the Medication Therapy Management Program.

Medication Therapy Management

It is the purpose of the Medication Therapy Management program to:

• Improve the quality of the health care provided to FHCP members in a cost effective manner.
• Optimize therapeutic outcomes for targeted members through improved drug utilization and medical management.
• Decrease the risk of adverse drug interactions.
• Decrease drug related adverse events and medication errors.

The Medication Therapy Management Program will:

• Assess patient's medication regimen in the context of the patient's medical history.
• Assess patient's understanding, utilization, and compliance with their medication regimen.
• Assess use of herbal and over-the-counter (OTC) products.
• Assess medication cost and assist in developing cost effective medication plans.
• Give suggestions to treating physicians and the patient based on adverse events, interaction risks, and adherence to clinical practice guidelines, utilizing formulary medications when possible.
• Alert physicians to possible patient non-compliance with prescribed medications.
• Alert patients to the risks of non-compliance with prescribed medications.
• Identify potential drug elimination problems which may result in adverse events.
• Give suggestions or summary of drugs or classes of drugs that should be avoided or given consideration based on patient specifics.
• Have congruence between what is prescribed and what is administered, in the patient file.
• Improve medical outcomes and patient safety.

It is the purpose of the Health Resource Delivery Complex Patient Care system to:

• Assess those patients with complex medical needs including but not limited to medication use.
• Identify areas for coordination of health care, including medical, psychiatric, medication, social, support and planning needs consistent with Medicare's CCIP.
• Create a care management plan (POC or plan of care) for these patients with input from the patient, physicians, pharmacists, nurses, social workers and other care givers.
• Implement the POC in conjunction with all the above, utilizing appropriate FHCP Health Promotion and Disease Management programs, and community resources.
• Monitor the patient progress.
• Adjust the plan as needed and communicate to all involved parties.

ELIGIBILITY FOR HEALTH RESOURCE DELIVERY/MEDICATION THERAPY MANAGEMENT PROGRAM:

• Medicare members projected to have at least $4000 in medication expenses per year, and
• Medicare members with 3 or more significant chronic diseases such as, but not limited to: diabetes mellitus, coronary heart disease, congestive heart failure and chronic renal insufficiency, and
• Medicare members taking more than 5 or more Part D medications for chronic illnesses.