Medication Therapy Management Program

If you're in a Medicare drug plan and have complex health needs, we can help you get the best results from the drugs you use. Medicare Plus BlueSM PPO and Prescription BlueSM PDP offer a Medication Therapy Management Program (MTMP) at no additional cost to qualifying members with the Part D drug benefit. Developed by a team of pharmacists and doctors, and coordinated in partnership with the University of Arizona, College of Pharmacy Medication Management Center, this program helps you and your doctor make sure that your medications are working safely and effectively.

We identify members with chronic diseases who may be at risk for medication-related problems and send them information about the MTM Program. Your enrollment in MTMP is free, voluntary, and does not affect your drug coverage under Medicare.

To qualify for the program, you must meet all of the following criteria:

  1. You must have at least two chronic medical conditions, such as diabetes, high blood pressure, high cholesterol, chronic obstructive pulmonary disease (COPD) or osteoporosis.
  2. You fill six or more prescriptions for Part D drugs each month.
  3. You spend at least $3,017 on medications in one year.

If you qualify for the program, we'll ask you to complete a Personal Medication List and send it to us for review. Download a copy of your Personal Medication List (PDF).

In a targeted review, a pharmacist routinely reviews your prescription drug medication list for possible problems or gaps. If we detect a problem, we contact you or your doctor to discuss.

In a comprehensive medication review, a pharmacist will contact you by telephone to discuss each of the medications on your list and answer any questions you may have. We'll prepare a personalized care plan and send you and your doctor educational materials to help you achieve your medication goals. We'll also periodically call you to keep up with any changes or new concerns you're having with your medication plan.

Your participation in MTM Program is voluntary; you can opt out of the program at any time by calling the number on the back of your Member ID card.

If you have questions about this program or want to know if you qualify, please call the number on the back of your member ID card..

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Important information about these plans

Medicare Plus Blue and Prescription Blue are PPO and PDP plans with a Medicare contract. Enrollment in Medicare Plus Blue and Prescription Blue depends on contract renewal.

Medicare Plus Blue PPO

Medicare Plus Blue PPO is available to all Medicare beneficiaries who are Michigan residents and are entitled to receive services under Medicare Part A and enrolled in Part B.

With the exception of emergency or urgent care, it will cost more to get care from non-plan or non-preferred providers. Your responsibility will be greater out-of-network when the out-of-network coinsurance is based on the Medicare-allowed amount and the contracted amount is lower. You may receive services from any provider who accepts Original Medicare. Your out-of-pocket costs will be lower if you choose a network provider. To find a network provider, visit http://www.bcbsm.com/medicare/find-a-doctor/.

Prescription Blue PDP

Prescription Blue PDP is available to all Medicare beneficiaries who are Michigan residents entitled to receive services under Medicare Part A and/or enrolled in Part B.

Medicare Plus Blue PPO and Prescription Blue PDP

Premiums vary by county. You must continue to pay your Medicare Part B premium. You may enroll in only one Part D plan at a time.

Limitations, copayments and restrictions may apply.

Our network includes approximately 2,400 Michigan retail pharmacies, representing approximately 98 percent of all Michigan pharmacies. Nationwide, most chain pharmacies are in our network, as well as long-term care and home infusion pharmacies and Indian/Tribal/Urban (Indian Health Service) pharmacies.

In general, benefits are only available at contracted network pharmacies. Plan drugs may be covered in special circumstances; for instance, illness while traveling outside of the plan's service area where there is no network pharmacy. You may have to pay more than your normal cost-sharing amount if you get your drugs at an out-of-network pharmacy. Quantity limitation and restrictions may apply. In addition, you will likely have to pay the pharmacy's full charge for the drug and submit documentation to receive reimbursement from Blue Cross Blue Shield of Michigan. For additional information on network pharmacies, please call Member Services at 1-877-241-2583, 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14. TTY users call 711. Certain services available 24/7 through our automated telephone response system. You may also write to: Blue Cross Blue Shield of Michigan, 600 E. Lafayette Blvd., Mail Code X521, Detroit, MI 48226.

If you decide to have your plan premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and or copayments/coinsurance may change on Jan. 1 of each year.

Medicare beneficiaries may enroll in Medicare Plus Blue PPO or Prescription Blue PDP through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. BCBSM does not control Medicare's website and is not responsible for its content. You may only enroll in Medicare Plus Blue PPO or Prescription Blue PDP during specific times of the year.

For more information, please contact Blue Cross Blue Shield of Michigan at 1-888-563-3307. TTY users call 711. Hours are: 8 a.m. to 9 p.m. Eastern time, Monday through Friday, Feb. 15 through Sept. 30, with weekend hours Oct. 1 through Feb. 14.

LegacySM Medigap

Legacy Medigap offers access to any hospital, doctor or other health care provider in the U.S. or its territories that accepts Medicare assignment. The plan does not require members to use a specified provider network. Legacy Medigap is a Medigap health insurance policy administered by Blue Cross Blue Shield of Michigan. Neither Blue Cross Blue Shield of Michigan nor agents authorized to sell Blue Cross Blue Shield of Michigan policies are connected with Medicare.