Our Services

A covered member (or member representative) meets with a pharmacist to review his or her entire medication profile–inclusive of prescription and non-prescription drugs, herbal products and nutritional supplements–to detect any conflicts, duplications or cost-saving opportunities. When complications are detected, the pharmacist consults with the member and/or prescriber to address the issue. In follow-up, the CMR recipient receives a Patient Takeaway that includes an updated Personal Medication List and a Medication Action Plan.

OutcomesMTM offers a range of adherence services that vary in intensity and may be targeted to members who are non-adherent or at risk of becoming non adherent.

• Adherence – Needs Check-in TIP: the pharmacist counsels the member on importance of adherence, identifies potential and/or existing barriers to adherence and works with the member to overcome any barriers
• Needs 90-day Fill TIP: the pharmacist assists the patient in transitioning from a 30-day supply to a 90-day supply
• Needs Refill TIP: the pharmacy proactively addresses refills
• Adherence Monitoring Program: the pharmacist monitors adherence and connects with the member throughout the year to meet or exceed the adherence target
• Medication Synchronization (MedSync): the pharmacist works to align a member’s chronic medications to a common fill date to simplify the refill process and encourage a regular conversations with the pharmacist to address any medication concerns.

Costs of treating chronic disease can increase exponentially without a multi-dimensional approach to mitigation. Disease Management interventions build a connection point with the pharmacist who can provide expertise and resources your member will need to manage their condition for years to come. A suite of personal interventions aid members in reducing adherence barriers, managing medication supply, optimizing regimens and understanding how to manage their condition. Our Disease Management solution can address a myriad of disease states, including the five most expensive:

• Behavioral health
• Congestive heart failure
• CVD / heart disease
• COPD
• Diabetes

Behavioral patterns, social circumstances and environmental factors can impact a member’s health as much as or even more than medical determinants. Because each member’s blend of social determinants is unique, identifying areas that negatively impact the member’s health requires personal interaction from a trusted healthcare provider. Community-based pharmacists in our network are well positioned to initiate this sensitive conversation and potentially connect the member with local support or resources.

For members discharged from the hospital to home, the pharmacist reconciles the pre- and post-discharge medication lists, looking for omissions, duplications, interactions and dosing concerns; deactivates any open prescriptions for discontinued medications; and distributes summaries to the prescriber and patient to close communication gaps.

The pharmacist consults with the prescriber and the member to prevent, mitigate and resolve drug therapy problems (DTPs). Interventions may include, but are not limited to:

• Closing gaps in care
• Resolving adverse effects or interactions
• Reducing use of unnecessary or potentially harmful therapy
• Addressing dosing concerns
• Recommending cost-effective alternatives

• Needs Medication Assessment TIP: A pharmacist assesses potential adverse events from the use of a medication with a heightened risk of causing significant harm. The pharmacist determines if the member is experiencing adverse events, educates the member on options to address any concerns and assesses if the member’s relevant disease state is controlled.
• Needs Patient Education TIP: the pharmacist counsels the member on healthcare topics such as annual exams, screenings, lab tests, disease management, etc. to help prevent future illnesses and ensure disease states are appropriately managed (i.e., well-child exams, comprehensive diabetes care or follow-up care for ADHD medication).
• Social Determinants Assessment: the pharmacist discusses with the member societal and domestic factors contributing to their health to assess potential changes to medication or adherence.