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14. Medication Therapy Management Program
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The Mercy Care Advantage (MCA) Medication Therapy Management Program (MTMP) Policies and Procedures are as follows:

A Medicare beneficiary must meet ALL three criteria below to be eligible for the MTMP.

1. The MCA Medicare Beneficiary must have a minimum of three (3) of the Chronic Diseases listed in the chart below.

	AIDs/HIV	X	Dyslipidemia
	Alzheimer’s/ Dementia		ESRD/Renal Failure/CKD
	Anemia		GI/Reflux/Ulcer Conditions
	Anticoagulation	X	Heart Failure
X	Asthma		Hepatitis C
	Behavioral Health	X	Hypertension
	BPH		Multiple Sclerosis
	Cancer		Osteoarthritis
	Cerebrovascular Disease		Osteoporosis
	Chronic Pain		Parkinson's Disease
X	COPD		Rheumatoid Arthritis
X	Diabetes

2. The MCA Medicare Beneficiary must have filled at least seven (7) of the Part D Drugs listed in the chart below within the past three (3) months.

	ACE-Inhibitors		Beta-blockers
	Alpha blockers		Bronchodilators
	Angiotensin II receptor blockers (ARBs)		Calcium channel blockers
	Anticoagulants		Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
	Antidepressants		Diuretics
	Antiemetics		Insulins
	Antihyperlipidemics		Interferons
	Antihypertensives		Oral hypoglycemics
	Antineoplastics		Proton Pump Inhibitors
	Antipsychotics		Selective serotonin reuptake inhibitors (SSRIs)
	Antiretroviral therapy		Tumor Necrosis Factors (TNFs)

3. The MCA Medicare Beneficiary must meet the MCA criteria for the Annual Incurred Cost for Part D Prescription Drugs.

• The MCA criteria for the Annual Incurred Cost for Part D Prescription Drugs is $4,000 annually. MCA will review the beneficiary’s past three (3) months of claim history. If the beneficiary has incurred a drug spend of over $1,000 in the previous three (3) months, they will have met the MCA criteria for annual drug spend likely to be over $4,000.

Note, the above program(s) are not considered a Mercy Care Advantage benefit.

If you have any questions regarding the Medication Therapy Management Program (MTMP), please contact our Member Services Department at:

602) 263-3000

or

(800) 624-3879

24 hours a day, 7 days a week