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. To help with this, you can have a specially trained clinician review all your medications with you. We partner with OutcomesMTM to help provide all WellSense Senior Care Options (SCO) members with this service. These clinicians can help answer any of your questions and work with you and your doctor to make sure your medications are appropriate, safe and effective. The Medication Therapy Management (MTM) program is not considered a benefit and is a free service for all eligible members.

Who is eligible?

Members are automatically enrolled quarterly into the MTM program if they meet all of the following criteria:

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 OutcomesMTM. Within a few weeks of receiving the letter, you will also receive a call from OutcomesMTM or WellSense to set up an appointment to speak to a clinician and complete a Comprehensive Medication Review (CMR).

What is a Comprehensive Medication Review?

The Comprehensive Medication Review (CMR) is done with you over the phone and will give you the opportunity to review all of your current medications with a pharmacist or other qualified clinician. This is a one-on-one, conversation by phone that takes about 30 minutes. 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 other 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.

Members 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 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 OutcomesMTM at 844-866-3730 (TTY: 800-367-8939).

You can also contact WellSense Member Services with any additional questions.

Last update 3/5/2024