Wellness Programs

Medication Therapy Management

As a Network Health Medicare Advantage member, you may be eligible to participate in our medication therapy management (MTM) program at no cost.

Medication

What is Medication Therapy Management?

This special program helps you and your doctor ensure medications are working to improve your health. The MTM program is offered through our partnership with Express Scripts Inc. and SinfoniaRx. It’s a program designed to help you manage your medications and do the following:

  • Improve your medication use.
  • Reduce the risk of dangerous drug reactions.
  • Make sure you’re taking medications correctly and as prescribed.
  • Ensure you are on the most appropriate and cost-effective medications.

Who Is Eligible?

To be eligible for the program, you must meet the following criteria.

  1. You must have at least three long-term (also called chronic) medical conditions. These may include:
    • Asthma
    • Chronic heart failure (CHF)
    • Chronic obstructive pulmonary disease (COPD)
    • Depression
    • Diabetes
    • End stage renal disease (ESRD)
    • High cholesterol levels
    • High blood pressure
    • Osteoporosis
  1. For long-term medical conditions, you must take seven or more daily medications covered by Medicare Part D.
  2. Your Part D covered medication must cost more than the Centers for Medicare & Medicaid Services specified annual cost threshold. For 2018, the threshold is $3,967, in 2019 it is $4,044.

How Do I Join the Program?

If you meet the eligibility requirements, you’re automatically enrolled in MTM and will receive the following at no cost to you:

  • An introductory letter on how to get started.
  • An offer to participate in a comprehensive medication review each year.
    • Review your medications with a pharmacist or other health care professional, including over the counter drugs and herbal products. This will help you get the best results from your medicines.
    • The review will take about 15-30 minutes and can be scheduled at a convenient time for you. During this call, any issues with your medicines will be discussed.
    • You will receive a letter outlining the review and recommended next steps.

See an example of the MTM Follow-Up Letter and Personal Medication List.

What Else Do I Need to Know?

  • This program is available at no cost to you.
  • You may participate every year that you meet the eligibility requirements.
  • Your participation in the program is voluntary.
  • Although you will automatically be enrolled, you may choose not to participate.
  • This is not a benefit of your plan, but rather a voluntary program.
  • If you do not meet eligibility requirements and would like your medications reviewed, let us know and we can help.

Where Do I Go for More Information?

To learn more about the program, or to find out if you qualify, call customer service at 800-378-5234 (TTY 800-947-3529) Monday–Friday, from 8 a.m. to 8 p.m.


Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.