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Molina Healthcare of Texas

Molina Medicare

Quality Assurance Policies & Procedures

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.

Our Quality Assurance program includes the following:

	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.
	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.
	Dose checks to ensure that medications are used within guidelines set by the Food and Drug Administration (FDA).
	Reporting of our quality assurance practices to the Centers for Medicare & Medicaid Services.

Medication therapy management program and drug utilization management

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:

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).

In addition to having two or more of the listed chronic conditions, member must also meet the following:

Member has filled six or more Part D prescriptions for chronic medications in 30 days, and
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.

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.

Please call our Member Services Department if you have any questions regarding participation in this program. Member Services 1-866-440-0012 (TTY/TDD 1-800-346-4128). (Hours of Operation: Monday through Sunday 8:00 a.m. to 8:00 p.m.).

*Paper copies of information posted on our web site are available upon request.

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.

Last Updated 01/14/2008