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Pharmacy Programs

Medication Therapy Management (MTM) Program

Pharmacy Tips/Newsletter

STARS / Quality Programs

Quality Assurance & Drug Utilization Management

St. Mary's ATRIO Health Plans is pleased to offer a free service to help ensure you are getting the most value from your medications and in the safest manner. This service is only for members enrolled in a plan that includes Medicare Part D prescription drug coverage.

Many
people are living longer, more active lives with the help of prescription drugs, over-the-counter medicines, vitamins and supplements. When you take the right medicines in the right way for the right health conditions, they are safe and effective tools for good health.

Personal Medication List


Medication Therapy Management (MTM) Program

St. Mary's ATRIO Health Plans utilizes MedWiseRx to offer Medication Therapy Management services to St. Mary's ATRIO Health Plans members who meet certain criteria. Through MedWiseRx, credentialed providers help members to manage their medications.

The credentialed providers are there to help you get the best results from your medication while keeping out-of-pocket costs down. MedWiseRx can give you the extra attention you need to keep your medications on the right track.

As an St. Mary's ATRIO Health Plans member, you are eligible for these important services at no additional cost if you meet the following criteria:


2022 Eligibility Requirements:

1. You must meet all of the following criteria:

a. You must have a total drug cost of over $4,696 a year on medications; AND

b. You must take 8 (eight) or more medications for chronic illness; AND

c. You must have 3 (three) or more chronic diseases:

  • Atrial Fibrillation
  • Bone Disease-Arthritis-Osteoporosis
  • Cardiovascular Disorders
  • Chronic Heart Failure (CHF)
  • Diabetes
  • End Stage Renal Disease (ESRD)
  • Respiratory Disease-Chronic Obstructive Pulmonary Disease (COPD)

OR

2. Members who are at-risk beneficiaries (ARBs) under a DMP (Drug Management Program) are also eligible for this program.


Comprehensive Medication Review (CMR):

A credentialed provider from MedWiseRx will meet with you face-to-face or via phone to review all your medications. This will help identify any duplications or conflicts and help to organize your medication schedule. Following the CMR, you will receive a Medication Action Plan and Personal Medication List.

  • Estimated Time Commitment: 30 minutes to 1 hour

Prescriber Consult

MedWiseRx will confer with you and your doctor(s), face-to-face or via phone to resolve any problems found with your medications.

  • Estimated Time Commitment: 5 to 15 minutes

Medication Adherence Guidance

MedWiseRx may ask how you take certain medications to ensure you take it as prescribed and work with you on any adherence barriers you may encounter.

  • Estimated Time Commitment: 5 to 15 minutes

Member Notification

  • Contact: Members that qualify for MTM will be contacted by MedWiseRx through the mail and phone.
  • Frequency: Throughout the year MedWiseRx will review members’ medication history to identify members for MTM.
  • Opt-Out: Eligible members are able to opt out of the MTM program as participation is voluntary. To opt out, please contact St. Mary's ATRIO Health Plans Customer Service at the number shown below.

Getting
started is easy. Simply call St. Mary's ATRIO Health Plans Customer Service Toll Free Daily, 8am - 8pm at 1-877-672-8620 (TTY 711).

The Medication Therapy Management Program is not a medical benefit, but a service provided by St. Mary's ATRIO Health Plans.

Pharmacy Tips/Newsletter

St. Mary's ATRIO
Health Plans is dedicated to providing members and health care professionals with the trusted information, resources, and education they need to optimize patient outcomes and improve care. Through integrated, multi-channel communications, education, and research we can help our members and health care professionals up to date with the latest guidelines and treatment options available, as well as new programs to save both time and money

STARS / Quality Programs

  • Medication Adherence Review: Medication adherence, oftentimes known as medication compliance, is when patients take their prescription drug correctly. This includes ensuring the drug is taken on time, in the correct dosage and for the length of time prescribed. If they don’t, the drug may not work like it should, which could cause additional side effects or have little to no effect at all. While there are many reasons why a patient might not take a drug correctly, St. Mary's ATRIO Health Plans is dedicated to improving adherence across the board while fostering a trusting and effective relationship between patient and practitioner.
  • Statin Use in Patients with Diabetes: The 2017 American Diabetes Association (ADA) Standards of Medical Care in Diabetes contains recommendations for the management of diabetes and its complications. High-dose statin therapy is recommended for all patients with diabetes with a history of clinical atherosclerotic CVD or with at least one additional CVD risk factor. Moderate-dose statin therapy is also suggested for patients younger than 40 or older than 70 who have CVD risk factors. St. Mary's ATRIO Health Plans monitor appropriate statin use in members with a diagnosis of Diabetes, keeping their providers informed and alerted to potential non-compliance.
  • Opioid Safety Review
    : St. Mary's ATRIO Health Plans recognize the clinical challenges to successfully managing pain and prescribing safely for our Plans members while implementing the Opioid Safety Oversight. We utilize concurrent drug utilization review (DUR) systems, policies, and procedures designed to ensure that a review of the prescribed drug therapy is performed before each prescription is dispensed to an enrollee as well as retroactive review of profiles to ensure safe and appropriate use of opioids is prescribed and adhered to

Quality Assurance & Drug Utilization Management

  • Prospective Drug Utilization Review (DUR): Some drugs may need to get preapproval (prior authorization) before starting to ensure the prescribed drug is safe, appropriate and medically necessary. Drugs covered under both Medicare Part D and Part B rules are evaluated for utilization management using the most current medical guidelines published, keeping patient safety first among priorities.
  • Concurrent Drug Utilization Review (DUR): At the pharmacy, computerized systems check for and alert your pharmacist about potential safety concerns, such as therapeutic duplication, drug interactions or allergies to reduce medication errors. We have set up these computer reviews in support of CMS requirements to address quality assurance, safety and concurrent drug utilization review.
  • Retrospective Drug Utilization Review (DUR): St. Mary's ATRIO Pharmacy Department and our partners analyze data and review reports of filled prescriptions to find instances of over- or under-utilization of drugs. We follow CMS Patient Safety measures and conduct this monitoring on a regular basis .