Drug Management Programs

Quality Assurance

AmeriHealth Caritas VIP Care Plus (Medicare-Medicaid plan) has created special programs to help you access your prescriptions safely — at the lowest cost to you.

Medication Therapy Management

AmeriHealth Caritas VIP Care Plus has partnered with PerformRxSM to offer medication therapy management (MTM) programs at no additional cost for members who:

  • Have multiple medical conditions
  • Take many prescription drugs
  • Have high drug costs

A team of pharmacists and doctors developed these MTM programs to help provide better prescription drug coverage for plan members. For example, these programs help us ensure that our members are using the proper drugs to treat their medical conditions. They also help AmeriHealth Caritas VIP Care Plus spot possible medication errors.

AmeriHealth Caritas VIP Care Plus offers MTM programs for members who meet certain criteria. As an AmeriHealth Caritas VIP Care Plus member, we may notify you about enrolling in the program.

AmeriHealth Caritas VIP Care Plus hopes that you will participate in any program to help you manage your medications. Remember, you do not need to pay anything extra to participate. If you are selected as an eligible participant for an MTM program, AmeriHealth Caritas VIP Care Plus will send you information about the specific program, including how to disenroll if you choose not to take part.

If you wish to join a program, our pharmacy benefits manager, PerformRx, will contact you by phone or mail with informational materials.

Our outreach to you should take less than 30 minutes to complete. You will be eligible for both the comprehensive medication review, which will be a review of all your medicines and therapy programs, and a targeted medication review, which will target your specific conditions. We will provide you an overview of the MTM program, a personal medication list (PDF), a recommended to-do list (PDF) based on your medications, and educational information based on your specific conditions.

If you decide to participate in this program, we will also contact your primary care provider (PCP) to discuss your current treatments to work to improve your conditions and outcomes. You can get any information we get from our consultations with your providers.

Every three months, we will send you materials for you to review. We ask that you review this information and provide us any updates so that we are aware of your current information. In addition to requesting updated information, we will offer you a chance to have a comprehensive medication review.

You may also receive extra information targeted at your specific conditions. These reviews can be helpful in checking your current drug treatment to ensure that you are receiving the best care.

To learn more, or to obtain MTM documents, call PerformRx at 855-328-0011 (TTY 1-888-765-6351), seven days a week, 24 hours a day.

2024 Medication Therapy Management

You are eligible for the Drug Management Program based on the Centers for Medicare & Medicaid Services (CMS) guidelines. These programs may have limited eligibility criteria and are not considered a benefit. They are available for the following conditions:

Having at least three of the following disease states:

  1. Asthma
  2. Chronic heart failure (CHF)
  3. Chronic obstructive pulmonary disease (COPD)
  4. Chronic and/or disabling mental health conditions
  5. Diabetes
  6. Dyslipidemia
  7. End-stage renal disease (ESRD)
  8. Hypertension
  9. Osteoporosis
  10. Rheumatoid arthritis

Being on at least five different medications from the following list to treat those disease states:

  1. Angiotensin-converting enzyme (ACE) inhibitors
  2. Angiotensin II receptor blockers (ARBs)
  3. Antidepressants
  4. Antihyperlipidemics
  5. Antihypertensives
  6. Antipsychotics
  7. Beta blockers
  8. Bisphosphonates
  9. Bronchodilators
  10. Calcium channel blockers
  11. Cardiac glycosides
  12. Colony-stimulating factors
  13. Calcimimetic
  14. Disease-modifying anti-rheumatic drugs (DMARDs)
  15. Diuretics
  16. Glucagon-like peptide-1 receptor agonists
  17. Inhaled corticosteroids
  18. Insulins
  19. Neprilysin Inhibitors
  20. Non-steroidal anti-inflammatory drugs (NSAIDs)
  21. Oral hypoglycemics
  22. Phosphate binders
  23. Selective serotonin reuptake inhibitors (SSRIs)
  24. Vitamin D analogs

Drug costs of $5,330 per year are likely to be incurred.

To learn more, or to obtain MTM documents, call PerformRx at 1-888-349-0501 (TTY 1-888-765-6351), 8:30 a.m. to 5 p.m., Monday through Friday.

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Members 2024