Medication Therapy Management

What is the Medication Therapy Management (MTM) program?

We understand that keeping track of multiple medications and dosing schedules can be difficult. That is why as a member of WellSense Senior Care Options (SCO), you can have a specially trained clinical staff such as a pharmacist or nurse review all your medications with you. These clinicians can help answer any of your questions and work with your doctor to make sure your medications are appropriate, safe, and effective. The MTM Program is not considered a benefit and is a free service for eligible members.

Who is eligible?

You are automatically enrolled into the MTM program weekly if you meet all of the following criteria:

  1. You have at least two (2) of the following chronic conditions:
    • Osteoporosis
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia
    • Hypertension
    • Depression
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Chronic Non-cancer pain
  2. You are taking at least eight (8) or more different covered Medicare Part D medications that are considered chronic or maintenance drugs
  3. You have an accumulated drug cost (not what you pay) of $1,234 in the previous quarter for covered Medicare Part D medications.

You are automatically enrolled into the MTM program weekly if you meet all of the following criteria:

  1.  You have at least three (3) of the following chronic conditions:
    • Osteoporosis
    • Chronic Heart Failure (CHF)
    • Diabetes
    • Dyslipidemia
    • Hypertension
    • Depression
    • Asthma
    • Chronic Obstructive Pulmonary Disease (COPD)
    • Chronic Non-cancer pain
  2. You are taking at least eight (8) or more different covered Medicare Part D medications that are considered chronic or maintenance drugs
  3. You have an accumulated drug cost (not what you pay) of $1,333 in the previous quarter for covered Medicare Part D medications

Eligible members will receive a Welcome Letter from our MTM partner, SinfoniaRx (a Cureatr Company). Within a few weeks of receiving the letter, you will receive a call from SinfoniaRx to set up an appointment to speak to a clinical staff member and complete a Comprehensive Medication Review (CMR).

What is a Comprehensive Medication Review?

The Comprehensive Medication Review (CMR) is a 30-minute one-on-one conversation with a clinician that can be completed over the phone or face-to-face. The CMR will give you the opportunity to review all of your current medications with a pharmacist or other qualified clinician. After completing the CMR, you will be mailed a personal medication list (PML) and a medication action plan (MAP). The PML will include your current prescription medications, over-the-counter medications and dietary and herbal supplements. The MAP will summarize what you and the pharmacist or another qualified clinician discussed during the CMR and discussion topics for you and your doctor.

We will also conduct ongoing Targeted Medication Reviews (TMRs) and your doctor may be contacted by mail if we identify any issues with your medications.

To help you track your medications, you can also download a blank Personal Medication List for your personal use.

You may also receive helpful information in the mail. This can include additional information about their medications and suggestions from our pharmacists or other qualified clinicians about how to make the most of your medications and WellSense benefits. This information can be helpful when meeting with your doctor or pharmacist.

For more information

We encourage you to take full advantage of this service. If you do not want to take part in the program, or if you have questions, please contact our MTM partner, SinfoniaRx at 844-866-3730 (TTY: 800-367-8939). You can also contact Member Services with any additional questions.

Last update 10/2/2023