2015 Medication Therapy Management (MTM) Program

Piedmont WellStar Medicare Choice (HMO) has partnered with Evolent Health Pharmacy Services to offer a Medication Therapy Management (MTM) program at no cost to you. The MTM program, while not part of a prescription drug benefit, is designed to help reduce the risk of side effects and drug interactions while also managing your out-of-pocket expenses. The program is fully paid by Piedmont WellStar Medicare Choice and there are no changes to your benefit once you are enrolled in the program.

To qualify for the MTM program you must meet, at a minimum, all of the following criteria:

    (1) Three or more chronic conditions consisting of;
  • Chronic Heart Failure
  • Bone Disease: Osteoporosis
  • Dyslipidemia
  • Hypertension
  • Diabetes
  • Respiratory Disease: Chronic Obstructive Pulmonary Disease
  • Respiratory Disease: Asthma
    (2) Taking 8 or more Part D maintenance medications for chronic disease; and,
    (3) Likely to incur a yearly drug spend of $3,138 or more.

All eligible members will receive a welcome letter with a description of the program and information on how to contact Evolent Pharmacy Services for more information. Invitations to participate in a live, interactive one-on-one Comprehensive Medication Review (CMR) with a pharmacist will also be provided. The CMR provides a one-on-one consultation to review all of your medications and medical conditions and answer any questions that you may have.

You may also have Targeted Medication Reviews (TMRs) performed on your behalf. TMRs are identified on a quarterly basis to address potential medication-related issues. When these issues are identified, a fax is sent to the prescriber(s) about the potential medication issue. The fax will describe the potential issue, provide suggested intervention(s), and include your recent prescription fill history. You may also receive information about a TMR directly when appropriate. This may include mailing of general educational materials in the form of a newsletter regarding a health topic.

Medicare requires that MTM programs automatically enroll members who qualify through the calendar year, but participation is voluntary, and you are given the opportunity to opt out at any time. The welcome letter provides instructions on how to opt out of the program.

If you would like information about the MTM program, please contact our Member Services Department or Evolent Pharmacy at 1-866-823-1633. (TTY users dial: 1-855-275-1266): Monday – Friday 9:00 AM – 5:00 PM Eastern. The member services department can be reached at 1-855-222-1047.

A copy of a blank Personal Medication List from the CMR standardized format can be found here.

Piedmont WellStar Medicare Choice is a Medicare Advantage HMO organization with a Medicare Contract. Enrollment in Piedmont WellStar Medicare Choice depends on contract renewal.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance] may change on January 1 of each year.

*Our hours of operation change throughout the year. We are available to take your call: Oct. 1 through Feb. 14 Monday through Sunday: 8 a.m. to 8 p.m., and Feb.15 through Sept. 30 Monday through Friday: 8 a.m. to 8 p.m. and Saturday: 8 a.m. to 3 p.m.