If you have complex health needs and are in a Medicare Advantage plan from WellFirst Health — provided by SSM Health Plan — you may be able to participate in a Medication therapy management (MTM) program. MTM is a free service offered by WellFirst Health, and provides a consultation with a pharmacist or other health care professionals to help you and your provider get the most value from your medications.
The program is not considered a benefit because not all enrollees will qualify for the MTM program. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS). Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.
To take part in this program, you must meet certain CMS criteria, which identifies people who have multiple chronic diseases and are at risk for medication-related problems. Contact our Customer Care Center at 1-877-301-3326 (TTY: 711) to see if you're eligible.
You will be automatically enrolled in this program if you meet all of these three requirements:
If you would like more information or don't want to take part in the MTM program, call Member Services at 1-877-301-3326 (TTY: 711).
If you meet these criteria, we will send you a letter informing you that you qualify and are automatically enrolled in the program. This letter will include general information about the MTM program, provide instructions to contact the MTM program and how to opt-out. The letter will include a form for you to fill out giving us information to better understand how to help you and how to schedule your Comprehensive Medication Review (CMR). The MTM program communicates with you by telephone and through the U.S. Postal Mail.
If you qualify, you can consult with a pharmacist or other health professional. They will guide you through a comprehensive review of all your medications. You can talk about how best to take your medications, your costs or any problems you’re having. This review normally lasts about an hour. You’ll get a written summary of this discussion. The summary has a medication action plan that recommends what you can do to make the best use of your medications, with space for you to take notes or write down any follow-up questions. You’ll also get a personal medication list that will include all the medications you’re taking and why you take them. The pharmacist will work collaboratively with your primary care provider to recommend any appropriate medication changes and ensure they are aware of important information discussed during the review.
If you are eligible, we will automatically enroll you in the program and send you information. If you decide not to participate, notify us, and we will withdraw you from the program. If you have any questions about these programs, contact our Customer Care Center at 1-877-301-3326 (TTY: 711).