Blue Care Network of Michigan: Medication safety

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Medication safety

Drug Utilization Review

For more information call:
1-877-469-2583
TTY 1-800-481-8704
Seven days a week
8 a.m. to 8 p.m. Eastern Time

We conduct drug utilization reviews for all of our members to make sure that they are receiving safe and appropriate care. These reviews are especially important for members who have more than one doctor who prescribe their medications. We conduct drug utilization reviews each time you fill a prescription and on a regular basis by reviewing our records. During these reviews, we look for medication problems such as:

Possible medication errors
Duplicate drugs that are unnecessary because you are taking another drug to treat the same medical condition
Drugs that are inappropriate because of your age or gender
Possible harmful interactions between drugs you are taking
Drug allergies
Drug dosage errors

If we identify a medication problem during our drug utilization review, we will work with your doctor to correct the problem.

Medication Therapy Management Programs

We offer medication therapy management programs at no additional cost for members who have multiple medical conditions, who are taking many prescription drugs, or who have high drug costs. These programs were developed for us by a team of pharmacists and doctors. We use these medication therapy management programs to help us provide better coverage for our members. For example, these programs help us make sure that our members are using appropriate drugs to treat their medical conditions and help us identify possible medication errors.

We offer medication therapy management programs for members who meet specific criteria. We may contact members who qualify for these programs. If we contact you, we hope you will join so that we can help you manage your medications. Remember, you do not need to pay anything extra to participate.

If you are selected to join a medication therapy management program, we will send you information about the specific program, including information about how to better manage your medications.

We enroll members in our Medication Therapy Management program if:

They have at least two of these chronic conditions:
- Congestive heart failure
- Diabetes mellitus
- Dyslipidemia
- Hypertension
- Chronic Obstructive Pulmonary Disease (COPD)
We expect they will have $3,000 or more in drug costs per year, and
They have 8 or more prescriptions (excluding antibiotics, topical preparations and over-the-counter medications).

We identify participants for the Medication Therapy Management program through medical and pharmacy claims data.

Medication Therapy Management is not a BCN Advantage benefit but is a service to ensure member safety, assist in providing optimal, effective drug therapy and decrease medication and medical costs for our members.

For more information please call:

Customer Service at 800-450-3680
TTY users should call 800-430-3211

Service hours are 8 a.m. to 8 p.m., seven days a week.

Learn more about your medications

Your health and safety is important to us. The following brochures can equip you with information that will help you better understand your medications.

Medication Safety (PDF) — Features tips and a checklist of questions you should have answers to before leaving your doctor’s office and pharmacy.
Sensible Medication Use (PDF) — Provides suggestions that can help you get information about your medications and use them correctly.

Learn more about generic medications at theunadvertisedbrand.com, which features a calculator that shows you how much you can save by moving to generic medications.

If you have any questions about your medications, please talk to your doctor or pharmacist. They can make informed decisions based on your personal health history and help you understand the right drug treatment program for you.

Important information about this plan

BCN Advantage HMO is available in these counties: Allegan, Barry, Bay, Calhoun, Clinton, Eaton, Genesee, Gratiot, Ingham, Ionia, Jackson, Kalamazoo, Kent, Lapeer, Livingston, Macomb, Midland, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ottawa, Saginaw, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw and Wayne. Premiums vary by county. You must continue to pay your Medicare Part B premium.

You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage HMO will be responsible for the costs. Out-of-network services authorized by BCN Advantage HMO will be covered.

If you are enrolled in BCN Advantage HMO Option 2 or Option 3, you must use a network pharmacy to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Our pharmacy network includes the majority of chain pharmacies, mail order through Medco or Walgreens, as well as long-term care and home infusion pharmacies. For additional information on network pharmacies, please call Customer Service at 800-450-3680, 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-430-3211. You may also write to: BCN Advantage HMO, 2311 Green Road, Ann Arbor, MI 48105.

The BCN Advantage HMO benefit information provided is not comprehensive. Additional information should be requested before making a decision about your coverage. For full information on BCN Advantage HMO benefits, current members should call our Customer Service department at 800-450-3680, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-430-3211. Prospective members should call 877-469-2583, from 8 a.m. to 8 p.m., seven days a week. TTY users should call 800-481-8704.

Benefits, formulary, pharmacy, network, premium and/or coinsurance may change on Jan. 1, 2011. Please contact BCN Advantage HMO for details.

If you decide to have your BCN Advantage HMO premium withheld from your Social Security check or deducted from your checking or savings account, it may take up to three months for the automatic deduction to begin. If your premium amount is currently withheld from your Social Security check or deducted from your checking or savings account and you wish to receive a monthly bill instead, the change may also take up to three months to become effective. During this time, you will be responsible for paying your premium.

BCN Advantage HMO is issued by Blue Care Network, which contracts with the federal government. BCN Advantage HMO’s contract with CMS is renewed annually and the availability of coverage beyond the end of the contract year is not guaranteed.

BCN Advantage HMO^SM is a health plan with a Medicare contract.

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page modified 09/29/2009