Medication therapy management

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.

Three requirements to enroll in MTM

You will be automatically enrolled in this program if you meet all of these three requirements:

  1. Have at least three of the following conditions or diseases:
    • Alzheimer's Disease
    • Chronic heart failure (CHF)
    • Diabetes
    • Dyslipidemia
    • Hypertension
    • Respiratory disease-asthma
    • Respiratory disease-chronic obstructive pulmonary disease (COPD)
  2. Take at least eight covered Part D medications
  3. Use medications that cost more than $4,376 for the year combined (your costs and WellFirst Health's costs)

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).

Next steps if you qualify

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.

Pharmacist consultation

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).

Two types of medication reviews

  • Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor, if we detect a potential problem.
  • Comprehensive medication review: at least once a year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. Following the review, you will get a written summary of this call, which you can take with you when you talk with your doctors.

    This summary includes:
    • Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications. 
    • Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

Questions? Contact us.

Senior man using phone and laptop in his living room.Members
Talk with our Customer Care Center at 1-877-301-3326 (TTY:711).
 
Not a member?
Talk with a WellFirst Health Medicare sales rep at 1-833-551-0565. You can also call to ask for information in alternate formats and languages. 

Mailing address

WellFirst Health Medicare Advantage
PO Box 56099
Madison, WI 53705-9399