Medicare Advantage Part D pharmacy benefits

Female pharmacist talking with senior female while standing in front of shelves of pill bottles.

Medications can play a significant role in your health care. The following information from WellFirst Health — Provided by SSM Health Plan — will help guide your decisions about medications and answer questions about your Medicare pharmacy benefits.


Help paying for prescriptions? 

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week
  • The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778
  • Your state Medicaid office.


Formulary (Covered drug list)

See a full list of covered medications in our comprehensive formulary

Medical management

Request authorization of services that require prior authorization. 

Find a pharmacy

Search for participating pharmacies and learn about our nationwide network available through our Medicare Advantage plans. Plus, learn about using out-of-network pharmacies.
Female pharmacist talks about medications with senior male patient

Utilization management for prescription drugs

Some covered medications have additional requirements – like a prior authorization requirement or coverage limits. See requirements and access prior authorization forms.
Female pharmacist gives senior man an injection.

Vaccine coverage

See how some vaccines are covered under the Part D benefit and when vaccines are covered under Medicare Part B.
Pharmacist discusses medication with senior male

Pharmacy benefit guidelines Q&A

Read common questions and answers about Medicare pharmacy Part D topics. 

Drug overutilization review program

See how we meet the CMS requirement to prevent clinically inappropriate overuse of opioid medicines and acetaminophen.

Medication therapy management program

Read about our medication therapy management program.

Pharmacy transition process

Learn about our pharmacy transition process when you:
  • are a new member
  • are a returning member
  • change care locations
  • have other special circumstances.

Coverage determinations, exceptions, appeals & grievances

Learn more about Part D appeals, grievances, exceptions and coverage determinations.
Contact our Customer Care Center if you need additional information, including:
  • How we control the use of services and costs
  • The number of appeals and grievances filed by our members
  • A summary description of how we pay our doctors
  • A description of our financial condition, including a summary of our most recent audit statement

Questions? Contact us.

Senior man looks over paper as he makes a phone call.Members
Talk with our Customer Care Center at 314-301-3326 (TTY:711).
 
Not a member?
Talk with one of our Medicare sales reps at 833-942-2158 (TTY:711) You can also call to ask for information in alternate formats and languages. 
 
View our Medicare disclaimer.
H8019_wellfirsthealth.com
Updated: 10/1/22