CareOregon pharmacy team seeks to reduce the risks of polypharmacy
By Kristen Benkstein, Pharmacy Clinical Coordinator, CareOregon
As part of the new CareOregon Advantage program for members with both Medicare and Medicaid, the CareOregon pharmacy department is launching a program to help decrease the risks of polypharmacy.
MUST-READ: The FDA recently announced that cases of breathing problems, some causing death, have been reported when promethazine was used in children less than 2 years old. The labeling of all forms of promethazine has been updated to indicate that the drug is contraindicated in children less than 2 years old. CareOregon has updated its formulary to reflect this warning and prescriptions for promethazine will no longer process for children less than 2. |
The Medication Therapy Management Program (MTMP) is a CMS-mandated program for the Part D benefit to ensure members taking multiple drugs for chronic medical conditions are receiving safe, appropriate, and cost-effective regimens.
CareOregon pharmacists will focus on identifying members at potential risk because of drug-drug interactions, drug-disease interactions, compliance, subtherapeutic doses, supratherapeutic doses, or less than optimal therapy according to evidence-based treatment guidelines.
- Members who meet ALL of the following criteria are eligible for enrollment:
- ≥ 3 of 7 diagnoses- asthma, CAD, hypertension, hyperlipidemia, DM, CHF, depression- in the preceding year: and
- ≥ 8 chronic, unique drugs (chronic is defined as ≥ 60 days supply in 90 days) and
- ≥ $1,000 in Part D drugs in a 90-day period
After a preliminary drug profile review of eligible members by a CareOregon pharmacist, a letter will be sent to the member’s provider outlining potential concerns and requesting support for member enrollment. We will then proceed with offering enrollment to the member, who may accept or decline. Additionally, we will notify members who met original eligibility criteria but were not found to have any potential issues about their right for elective enrollment if they desire.
Upon member enrollment, a team of pharmacists and/or case management nurses and the Medical Director will conduct a more thorough review of drug and medical utilization. We may request relevant medical records from you so that we have a complete picture of the member’s history and treatment plan(s). We will then work with the member and his/her primary care team to develop a care plan. This may involve one-time medication recommendations, efforts to improve drug adherence and disease self management or a comprehensive plan for ongoing monitoring in order to achieve the member’s health care goals.
The goal of the MTM program is to support our providers in managing complex patients on multi drug regimens. Your feedback is always appreciated. If you have suggestions or questions about the program please call 503-416-4100 or l-800-224-4840, from 8 a.m. to 5 p.m., Monday through Friday.
