Taking Care of You
True Health New Mexico is focused on supporting our members to reach their optimal level of wellness and empowering our members to take charge of their health. Our Care Management team has several programs focused on addressing chronic and/or complex medical conditions. Our team consists of RN Care Managers and Care Coordinators who work closely with other members of our Medical Management team: doctors, pharmacists, and social workers.
Care Management Consists of Two Distinct Programs
- Case Management programs
- Chronic Condition programs (sometimes called Disease Management)
Case Management Program
True Health New Mexico has a Case Management Program to help members and their caregivers who have multiple or complex medical problems. Our Case Management program can help you to:
- Learn more about your condition and the treatment recommendations from your providers
- Develop self-management strategies so you can take charge of your health
- Answer questions about how to access care within the True Health New Mexico network of providers
Chronic Condition Programs
Enhanced Diabetes Program
Our Enhanced Diabetes Management program is tailored to our high-risk members with diabetes and other chronic conditions, such as high blood pressure and high cholesterol, who may be having challenges managing their health. When we select members for the program, we offer them an incentive for their ongoing participation.
- The Enhanced Diabetes Management program includes a consultation and quarterly monitoring by a registered nurse to support medication adherence to related to diabetes, high blood pressure, and high cholesterol.
- In addition, participating members are eligible for a no-cost medication review by our Director of Pharmacy.
- If appropriate, our pharmacist will coordinate with the member’s provider for therapy change recommendations.
If you are interested in learning more about the program and your eligibility, please call our Medical Management Department at 1-844-691-9984.
How to Get Your Diabetic Supplies
We want you to have easy access to the supplies you need. Some supplies are covered by your pharmacy benefit, and some are covered by your medical benefit.
Blood glucose testing supplies, diabetic medications, and select continuous glucose monitors (CGMs) may be covered by your pharmacy benefit.
- FreeStyle Libre and Dexcom G6 CGMs require prior authorization for use under the pharmacy benefit.
- If approved, FreeStyle Libre will pay at the preferred drug tier, while Dexcom G6 will pay at the non-preferred drug tier.
Other CGM brands and models may be covered under your medical benefit.
You can get glucose meters, blood glucose strips, lancets, insulin, and injectable and oral diabetic medications that are covered on your formulary (drug list) through the in-network pharmacy where you receive your other medications.
True Health New Mexico members can also receive a free OneTouch® blood glucose meter when a prescription is written by an in-network provider and filled at an in-network retail pharmacy.
Insulin pumps and supplies are covered by your medical benefit.
Please contact one of the following Durable Medical Equipment (DME) companies that specialize in these types of supplies.
Asthma and Diabetes Medications on Our Drug List
If you have asthma or diabetes, visit our Pharmacy page and click on the button underneath Do You Have Asthma or Diabetes? to find a list of medications and supplies we cover for those conditions. Several of these medications are on our $0 copay list.
Transition of Care Program
If you are receiving an ongoing course of treatment from an out-of-network provider at the time of your enrollment with True Health New Mexico, you may be eligible to continue to receive services from this provider and have the services covered under your True Health plan. This is called transition of care.
Transition of care covers certain medical conditions, including:
- Pregnancy in the second or third trimester
- Chemotherapy or radiation therapy
- Recent major surgeries
- Hospital confinement
- Other conditions
To be considered for transition of care coverage, you must apply for it either at enrollment or no later than 30 days after your effective date of coverage. True Health New Mexico will make determinations for transition of care based on established medical criteria.
Get started by downloading the Transition of Care Guide on our Member Forms and Documents page. There is a form for you to complete and submit at the end of the guide.
How to Access Care Management Services
If you are interested in Care Management services:
- You can complete and submit our secure online enrollment form.
- You can call us directly at 1-844-691-9984.
- You can use our secure messaging portal to enroll or request information. Please do not use regular email, as this is not secure.
- You also can be referred by your caregiver, doctor, or other provider, such as a hospital case manager. If you are referred by a provider, he or she will need to complete the Complex Case Management Referral Form on our Provider Forms page. Please ask your provider to fax the completed form to us.
Participation in these programs is your choice. You may leave the programs at any time.
Opting in and out of Our Programs
Our Care Management Programs are optional. They will not cost you anything extra, and you can quit the programs at any time. Your health plan benefits will not change whether or not you choose to take part in these programs.
If you choose to opt out of any of our programs, you can do so in the following ways:
- Call the Medical Managment department at 1-844-691-9984
- Email us via the secure messaging portal.