Notice to Providers: Members with Jefferson Health Plans Medicare Advantage plans may receive a call from these contracted programs on behalf of Jefferson Health Plans.

Magellan Rx Management, a Prime Therapeutics Company

Jefferson Health Plans has partnered with Magellan Rx Management, a Prime Therapeutics Company to do outreach to Jefferson Health Plans Medicare Advantage members, providers and/or pharmacies to ensure that members are filling and taking medications as prescribed.

Medication Adherence Program Description: Outreach to Medicare Advantage members who are in the denominator for one or more of the STARs medication adherence measures. This program focuses on increasing medication adherence rates in members with diabetes, hypertension and/or high cholesterol. The goal is to increase the percentage of members who are at least 80% adherent throughout the calendar year to their prescription for an oral diabetes medication, RAS antagonist and/or statin medication.

Statin Use in Persons with Diabetes (SUPD) Program Description: Increase the percentage of members 40-75 years of age who have at least two fills of diabetes medications during the calendar year AND have a fill for at least one statin or statin combination medication in the calendar year.

Members who qualify for the medication adherence program and/or SUPD program may receive a call from Magellan Rx, a Prime Therapeutics Company, on behalf of Jefferson Health Plans to discuss their medications.

Outcomes

Jefferson Health Plans has partnered with Outcomes to provide Medication Therapy Management (MTM) services to qualifying Medicare Advantage members at no additional cost to members. Our MTM Program helps members and providers make sure that medications are working. It also helps to identify and reduce possible medication problems.

To qualify for our MTM program, a member must meet one of the two following criteria:

• Be an At-Risk Beneficiary as defined by internal drug management program data and/or Medicare Advantage Prescription Drug System (MARx) data

Or

• Meet ALL of the following criteria:
• Take at least eight chronic/maintenance, covered Part D medications, AND
• Are likely to have medication costs of covered Part D medications greater than $5,330 per year.

• Have at least three of the following conditions: Osteoporosis, Chronic Heart Failure (CHF), Diabetes, Dyslipidemia, Hypertension, AND

Medication Management Support

Extended Day Supply Prescriptions and Deliveries/Mail Order

When appropriate, write up to 100-day prescriptions for our members with chronic conditions. Up to 100-day prescriptions can:

• Provide members cost savings
• Mean less visits to the pharmacy
• Increase medication adherence

*Note: Extended Day Supply-day supplies are not available for specialty drugs.

• Review our formularies

Mail Order

• Mail order pharmacy is a fast and convenient way to get members’ medications they need delivered right to their door. Plus, it’s included with their Jefferson Health Plans Medicare Advantage benefits.
• To have medications filled through mail order pharmacy, prescriptions can be sent to CVS Caremark Mail Service Pharmacy. Members can also request that CVS Caremark Mail Service Pharmacy contact their doctor and get the process started. Visit Caremark.com/mailservice or call 1-855-582-2023
• Not all covered medications are available through mail order.

Some Jefferson Health Plans participating pharmacies offer a medication home delivery option.

Barriers to Filling Prescriptions/Taking Medications

Barriers	Solutions
Too many medications to take at different times throughout the day. Forgetfulness or lack of understanding about how to take the medication.	Come up with a routine with your patients so they know when to take their medication. This can include setting a reminder or alarm and using pill boxes to organize medications.
New prescription or refills needed	Submit an e-prescription.
Unable to leave home to pick up medications from pharmacy	Talk to your patient about having their medications delivered to their door. Many pharmacies offer this service at no additional cost. See Jefferson Health Plans Provider Website for more details.
Concern about side effects	Be sure to review potential side effects of medication and possible interactions with other medications.
Cost of medications is too high	Review potential cost savings in having their medication switched to extended day refills/mail order where appropriate.
Patient doesn’t know why they are taking the medication	Review medications and treatment plan with your patient. Consider referral to care management or clinical pharmacist if available.