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| Molina Medicare |
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Quality Assurance
Policies & Procedures |
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| Molina Medicare has established
quality assurance measures and systems in order to make
sure that medications are used in a safe and effective
manner. Our goal is to prevent medication errors and
adverse drug reactions. |
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Our Quality Assurance program includes the following: |
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Drug utilization review systems designed to ensure
that a review of your drug therapy is performed
before each prescription is dispensed, such as
potential drug therapy problems due to
over-utilization, under-utilization, drug-drug
interactions, and drug-allergy interactions. |
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Computerized drug utilization review systems
designed to ensure ongoing periodic examination of
prescription data and other records in order to
identify drug therapy problems among Molina Medicare members. |
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Dose checks to ensure that medications are used
within guidelines set by the Food and Drug
Administration (FDA). |
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Reporting of our quality assurance practices to the
Centers for Medicare & Medicaid Services. |
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Medication therapy management program and drug
utilization management |
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Molina Medicare
offers medication therapy management programs for
members who meet specific criteria. This is not part of
your benefit structure, but rather a program to help you
understand what your medications are doing for you and
to help you take control over your medications. The
following criteria are used to identify eligible
participants in the MTMP: |
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Member must
have two or more of the following
chronic conditions: Diabetes, Hypertension, Ischemic
Heart Disease, Heart Failure, Hyperlipidemia, Asthma, or
Chronic Obstructive Pulmonary Disease (COPD). |
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In addition to having two or more
of the listed chronic conditions, member must also meet
the following: |
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Member has
filled six or more Part D prescriptions for chronic
medications in 30 days, and
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Member is projected to exceed
annual prescription medication costs of $4,000.
Medication cost will be calculated based on
annualizing one month of pharmacy claims data.
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Members will be
informed of their selection for this special program and
have the opportunity to decline entirely or participate
in the program at a lower level of
intervention. |
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Please call our Member Services
Department if you have any questions regarding
participation in this program. Member
Services 1-800-665-0898
(TTY/TDD 1-800-346-4128). (Hours of
Operation: Monday through Sunday 8:00 a.m. to 8:00
p.m.). |
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*Paper copies of information posted
on our web site are available upon request. |
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| Molina Medicare is an organization with a
Medicare contract. This contract is renewed annually,
and coverage beyond the end of the contract year is not
guaranteed. |
