Members

We may call to check on you when certain medications are refilled late or if you have been late refilling medications in the past.

You can also speak with a pharmacist who can help you overcome any barriers keeping you from getting and taking your medicine. The pharmacist can offer helpful tips, provide you with reminder tools or help transfer your prescriptions to mail order.

The Medication Therapy Management (MTM) Program is a free service that helps make sure your medicines are safe, work well and fit your daily life. Our team of pharmacists will work with you one-on-one to help you get the best results from the medicines you take. If we see any issues with your medicines, we can also work with your doctor. This service is not part of your prescription drug benefit.

Blue Advantage reviews your pharmacy and medical claims every month to see if you qualify. If you qualify, you are automatically enrolled in the program for the rest of the calendar year.

To qualify for the 2026 MTM program, you must meet all three of the following criteria:

• You have three of the following conditions:
• Alzheimer’s disease, bone disease (osteoarthritis, rheumatoid arthritis, osteoporosis), chronic heart failure, diabetes, high cholesterol, high blood pressure, end-stage kidney disease (ESRD), chronic mental health disorders, HIV/AIDS, chronic respiratory disease (asthma, COPD), AND
• You are taking eight or more chronic/maintenance (covered Part D) medications, AND
• You spend more than $1,276 in prescription drug costs during the calendar year, including amounts paid by both you and Blue Advantage OR
• You are enrolled in a Drug Management Program that helps you better manage and safely use your medications such as those used for pain

If you qualify, you will receive a letter inviting with information on how to schedule your 15–20-minute phone call for a detailed medication review. During that call, a pharmacist will complete a comprehensive medication review of your medicines and talk with you about:

• Any questions or concerns about your prescription or over-the-counter medicines, such as drug safety and cost
• Better understanding your medicines and how to take them
• How to get the most benefit from your medicines

After your review, you will receive a summary letter that includes an action plan and a complete list of your medicines, how you take them and what you take them for. This letter will be delivered to you by mail. If you prefer, it can also be delivered by email. You can ask for extra copies at any time.

At least once every 3 months, we check your medicines to make sure there are no issues that need attention. If we find something important, we may contact your doctor. We may also contact you by phone or letter to share updates or next steps.

Enrollment in the MTM Program is automatic once you meet all criteria to qualify; however, this service is voluntary. You are not required to participate. Your prescription coverage will not change whether you participate or not.

To opt out:

• Call 1-833-955-3820 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. CST ·
• Email: blueadvantageclinicalpharmacy@lablue.com
  If requesting to opt out by email, please include your full name, date of birth and reason for requesting to opt out.

If you change your mind later, you can rejoin the program with a simple call or email.