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 1-800-665-1029, 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.
