A letter offering a free review of every medicine you take may be offering a benefit you are owed. Plans with Medicare drug coverage must offer Medication Therapy Management, a service that usually includes a review of your medicines, to people who meet certain requirements, and if you qualify, you can get it at no cost. The same letter could also be a scam. In one kind of Medicare fraud, a scammer may ask you to confirm your Medicare number and then misuse it, and in another, a company may offer you a fake Medicare drug plan. Ask your own drug plan, at a number you look up yourself, whether the offer is real and whether you qualify. If your drug coverage is not through Medicare, ask your insurer the same two questions, calling the number your insurance card lists.
What the letter is offering when the offer is real
If you have Medicare drug coverage, the review your plan must offer is called Medication Therapy Management. It usually includes a discussion with a pharmacist or another health care provider to review your medicines, and it will help you manage them and take them safely. Through it you may get:
- a comprehensive review of your medicines and the reasons you take each one
- a written summary of the review you had with your doctor or pharmacist
- a Recommended To-Do List and a Medication List, with space on them for your notes and any follow-up questions
Before the pharmacy fills any prescription, your plan and pharmacist already run routine safety checks, such as checking for drug interactions. The comprehensive review you may get through Medication Therapy Management is a wider look than that, at all your medicines together.
A pharmacy's name on the letter shows nothing about whether the offer is real or whether you qualify. Medicare drug coverage is offered by insurance companies and other private companies approved by Medicare, and your own plan holds the specific details of who is eligible. If you take drugs for more than one chronic health condition, contact your drug plan to find out whether you are eligible.
Telling a real offer from an impersonation without giving anything away
Keep your Medicare number from anyone who calls you unexpectedly, and from the sender of the letter too. No one from Medicare will phone or visit you at home to sell you anything, and a Medicare representative asks for your information only if you contacted Medicare first. Any phone number printed in the letter was chosen by whoever sent it, so it cannot confirm who that was.
So make the first contact yourself, in this order:
- Find your plan's phone number. Your plan's contact information is generally on your plan membership card, and if you have lost the card and do not know the number, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) to get your plan's contact information.
- Phone your drug plan on that number and ask whether it offers Medication Therapy Management, whether you are eligible, and whether the letter you received came from the plan or from a pharmacy or provider working for it.
- If the plan says neither it nor anyone working for it sent the letter and you suspect fraud, call 1-877-808-2468 to reach your local Senior Medicare Patrol, or call Medicare at 1-800-MEDICARE.
If you have already given your Medicare number to someone who contacted you, keep an eye on the statements your plan and your medical providers send you. If you spot a mistake or an inconsistency, ask your medical provider or plan to explain it. If someone uses your information to get medical care or services, notify your provider or plan, and report the theft at IdentityTheft.gov to get a personalized plan to help you recover.
If your plan writes to you about opioids
A letter your plan writes to you about opioids concerns its drug management program, which is separate from a medication review. If your plan decides your use of prescription opioids and benzodiazepines may be unsafe, it will send you a letter explaining its review and may place you in a drug management program. These programs generally don't apply if you have cancer or sickle cell disease, are getting palliative or end-of-life care, or are in hospice or live in a long-term care facility. Anyone placed in one is also among the people the plan must offer Medication Therapy Management to.
| What to check | An offer of Medication Therapy Management | A letter about a drug management program |
|---|---|---|
| Who it is for | People who meet certain requirements, or who are in a drug management program | People whose use of prescription opioids and benzodiazepines the plan decides may be unsafe |
| What it looks at | All your medicines, and the reasons you take them | Prescription drugs like opioids and benzodiazepines |
| What may come of it | A written summary, a Recommended To-Do List and a Medication List | The plan may limit your coverage of these drugs, or require you to get them from one doctor or pharmacy you select |
| What you can do | Contact your drug plan to find out whether you are eligible | Appeal with your doctor if you disagree with the plan's decision. First confirm with your plan, on a number you looked up yourself, that it sent the letter, then use the contact details the letter gives |
Preparing for the review so it is worth your time
Take a record of every medicine you use, prescription and over-the-counter, together with your vitamins, herbals and other supplements. Give it to the pharmacist and say exactly how you take each one (see When four doctors prescribe, ask one to review the whole list). If you fill prescriptions at more than one pharmacy, include the medicines from all of them, even when the pharmacies belong to the same chain, and add anything you have stopped taking.
Some of what the pharmacist needs is not on that record. Tell them about any medical conditions you have or have had, including abnormal lab results. Describe any allergic reaction or other problem you have had with a medicine, a dietary supplement, a food, a medical device or another treatment, and what happened, whether your throat swelled, you got a rash, or it was a stomach ache or diarrhea. If you have started something new, or plan to, such as a diet or an exercise regime, mention it, because the pharmacist can help you avoid medicines, supplements, foods and other things that don't mix well with what you take. Changes to your insurance plan, policy or card are worth saying too.
Practical problems count as well. Anything that could affect your use of a medicine belongs in the conversation, such as trouble with:
- swallowing
- reading small labels
- understanding English
- remembering to take your medicine
- telling one medicine from another by how it looks
- paying for your medicines
- getting to the pharmacy
The pharmacist may be able to help with any of these, so raise them. If paying is the trouble, ask whether there are cheaper options, whether a generic is available, and whether there are co-pay assistance coupons.
Afterwards, check what the review produced, such as a written summary or the two lists, and use the space on the lists for the follow-up questions you still have. If you are prescribed a new medicine after the review, ask the pharmacist whether it will take the place of anything else you take, and whether you will need tests to check its effects. For each medicine you already take, ask the pharmacist which side effects to watch for, which are serious, and what to do if you get one. Bring your medication list any time you talk with your doctors, pharmacists and other health care providers, and if you go to the hospital or emergency room.
If a physician prescribes you a weight medicine through NicoCares, it goes on that list with the rest (see A weekly weight medicine can change how some of your other tablets work). If the review raises a question about it, or you start a new medicine afterwards, tell your NicoCares care team promptly by messaging them in Spruce, which you joined through the invitation you were emailed. Whether to change or stop the weight medicine itself is the prescribing physician's decision.
