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Molina Healthcare of New Mexico |
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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 1-866-440-0127
(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. |
