Pharmacy Programs

Medication Therapy Management (MTM) Program

Quality Assurance & Drug Utilization Management

ATRIO Health Plans is pleased to offer a free service to help ensure you are getting the most value from your medications in a safe manner. This service is only for ATRIO members enrolled in a plan that includes Medicare Part D prescription drug coverage.

With the help of prescription drugs, over-the-counter medicines, vitamins, and supplements people are living longer maintaining active and productive lives. When you take the right medicines, in the right way for your health conditions, they are a safe and effective tool for good health.

MTM Program

ATRIO Health Plans utilizes Aspen RxHealth to offer Medication Therapy Management services to ATRIO Health Plans members who meet certain criteria. Through Aspen RxHealth, credentialed providers help members to manage their medications.

The credentialed providers are there to help you get the best results from your medication while keeping out-of-pocket costs down. Aspen RxHealth can give you the extra attention you need to keep your medications on the right track.

As an ATRIO Health Plans member, you are eligible for these important services at no additional cost if you meet the following criteria:

2026 Eligibility Requirements:

1. You must meet all of the following criteria:

a. You must have a total drug cost of over $1,276 a year on medications; AND

b. You must take 8 (eight) or more medications for chronic illness; AND

c. You must have 3 (three) or more chronic diseases:

Alzheimer’s Disease
Bone Disease (arthritis, osteoarthritis, osteoporosis, rheumatoid arthritis)
Chronic Congestive Heart Failure (CHF)
Diabetes
Dyslipidemia
End Stage Renal Disease (ESRD)
HIV/AIDS
Hypertension
Mental Health (depression, schizophrenia, bipolar disorder, chronic/disabling mental health conditions)
Respiratory Disease- (Chronic Obstructive Pulmonary Disease (COPD), asthma, chronic lung disorders)

2. Members who are at-risk beneficiaries (ARBs) under a DMP (Drug Management Program) are also eligible for this program.

.

Comprehensive Medication Review (CMR):

A credentialed provider from Aspen RxHealth will meet with you face-to-face or via phone to review all your medications. This will help identify any duplications or conflicts and help to organize your medication schedule. Following the CMR, you will receive a Medication Action Plan and Personal Medication List.

Estimated Time Commitment: 30 minutes to 1 hour

Prescriber Consult

Aspen RxHealth will confer with you and your doctor(s), face-to-face or via phone to resolve any problems found with your medications.

Estimated Time Commitment: 5 to 15 minutes

Medication Adherence Guidance

Aspen RxHealth may ask how you take certain medications to ensure you take it as prescribed and work with you on any adherence barriers you may encounter.

Estimated Time Commitment: 5 to 15 minutes

Member Notification

Members that qualify for MTM will be contacted by Aspen RxHealth via mail and phone.
Throughout the year Aspen RxHealth will review members’ medication history to identify members for MTM.
Eligible members are able to opt out of the MTM program as participation is voluntary. To opt out, please contact ATRIO Health Plans Customer Service at 877-672-8620 Daily 8 AM to 8 PM Pacific Timezone.

Getting started is easy. Simply call Aspen RxHealth MTM Toll Free at 1-888-843-5779.

Monday - Friday 8:00 a.m. to 5:00 p.m. Eastern Standard Time; for patient calls, Daily 8:00 AM - 8:00 PM (patient's time zone).

The Medication Therapy Management Program is not a medical benefit, but a service provided by ATRIO Health Plans.

For information about the MTM program and how to obtain MTM service documents, or to see if you qualify, you can call the number 1-866-277-3679.

Pharmacy Tips/Newsletter

ATRIO Health Plans is committed to providing members and health care professionals with trusted information, resources, and education to optimize patient outcomes and improve quality of care. Through integrated, multi-channel communications, education, and research we can help our members and health care professionals with the latest guidelines and prescription treatment options available. We also help members to engage with prescription programs to help save time and money. Please contact our Customer Service Department for more information.

STARS / Quality Programs

Medication Adherence Review: Medication adherence, oftentimes known as medication compliance, is when patients take their prescription drug correctly. This includes ensuring the drug is taken on time, in the correct dosage and for the length of time prescribed. If they don’t, the drug may not work like it should, which could cause additional side effects or have little to no effect at all. While there are many reasons why a patient might not take a drug correctly, ATRIO Health Plans is dedicated to improving adherence across the board while fostering a trusting and effective relationship between patient and practitioner.
Statin Use in Patients with Diabetes: The 2017 American Diabetes Association (ADA) Standards of Medical Care in Diabetes contains recommendations for the management of diabetes and its complications. High-dose statin therapy is recommended for all patients with diabetes with a history of clinical atherosclerotic CVD or with at least one additional CVD risk factor. Moderate-dose statin therapy is also suggested for patients younger than 40 or older than 70 who have CVD risk factors. ATRIO Health Plans monitor appropriate statin use in members with a diagnosis of Diabetes, keeping their providers informed and alerted to potential non-compliance.
Opioid Safety Review: ATRIO Health Plans recognize the clinical challenges to successfully managing pain and prescribing safely for our Plans members while implementing the Opioid Safety Oversight. We utilize concurrent drug utilization review (DUR) systems, policies, and procedures designed to ensure that a review of the prescribed drug therapy is performed before each prescription is dispensed to an enrollee, as well as retroactive review of profiles to ensure safe and appropriate use of opioids is prescribed and adhered to.

Q.A. & Drug Utilization Management

Prospective Drug Utilization Review (DUR): Some drugs may need to get preapproval (prior authorization) before starting to ensure the prescribed drug is safe, appropriate and medically necessary. Drugs covered under both Medicare Part D and Part B rules are evaluated for utilization management using the most current medical guidelines published, keeping patient safety first among priorities.
Concurrent Drug Utilization Review (DUR): At the pharmacy, computerized systems check for and alert your pharmacist about potential safety concerns, such as therapeutic duplication, drug interactions or allergies to reduce medication errors. We have set up these computer reviews in support of CMS requirements to address quality assurance, safety and concurrent drug utilization review.
Retrospective Drug Utilization Review (DUR): ATRIO Pharmacy Department and our partners analyze data and review reports of filled prescriptions to find instances of over- or under-utilization of drugs. We follow CMS Patient Safety measures and conduct this monitoring on a regular basis.

MDPP

What is the Medicare Diabetes Prevention Program?

The Medicare Diabetes Prevention Program is a health behavior change program to help you prevent type 2 diabetes. The first part of the program lasts 6 months and includes 16 core sessions. Medicare Diabetes Prevention Program sessions are held in a group setting and provide the following:

Training to make realistic, lasting behavior changes to improve health
Tips on how to get more exercise
Strategies for controlling your weight
A behavior coach, specially trained to help keep you motivated
Support from people with similar goals

After you complete the 16 core sessions, you continue to receive help and support, including the following:

6 monthly follow-up sessions to help you maintain healthy habits
An additional 12 months of maintenance sessions if you meet certain goals

How Medicare covers the Medicare Diabetes Prevention Program

Medicare Part B (medical insurance) provides one-time coverage for the Medicare Diabetes Prevention Program if all three of these conditions apply:

1. You have a high blood glucose test result including one of the following:

Hemoglobin A1c (HbA1c) between 5.7 and 6.4 percent;
Blood glucose of 110-125mg/dL when fasting (not eating or drinking for at least 8 hours); or a 2-hour plasma glucose (oral glucose tolerance test) of 140-199mg/dL within 12 months of attending the first program session.

2. Your body mass index (BMI) is 25 or more (23 or more if you’re Asian).

3. You have never been diagnosed with type 1 diabetes, type 2 diabetes or End-Stage Renal Disease (ESRD). Medicare Advantage plans (Part C) also cover the Medicare Diabetes Prevention Program. Talk to your plan provider for coverage details.

How much does the Medicare Diabetes Prevention Program cost?

The Medicare Diabetes Prevention Program is a covered preventive service. That means you pay nothing and the Medicare Part B deductible does not apply.

However, you must attend a “recognized” program – one that meets all the standards set by the Centers for Disease Control and Prevention (CDC) and is a recognized Medicare supplier for the benefit. Programs that do not have this designation may not be covered.

For more information about the Medicare Diabetes Prevention Program, please visit: www.medicare.gov.

Last updated Dec 30, 2025