Medication Therapy Management (MTM) Program

We will automatically enroll you in the Wellcare By Fidelis Care program at no cost to you if all three conditions apply: 

1. You take eight or more Medicare Part D covered chronic or maintenance drugs, and
2. You have three or more of these long-term health conditions:
   • Alzheimer’s Disease
   • Bone Disease – Osteoporosis, Osteoarthritis, Rheumatoid Arthritis
   • Chronic Heart Failure
   • Diabetes
   • Dyslipidemia – High Cholesterol
   • End-Stage Renal Disease
   • Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome – HIV/AIDS
   • Hypertension
   • Mental Health – Depression, Schizophrenia, Bipolar Disorder, and other chronic/disabling mental health conditions
   • Respiratory Disease – Asthma, Chronic Obstructive Pulmonary Disease
3. You reach $5,330 in yearly prescription drug costs paid by you and the plan in 2024 or you reach $1,623 in yearly prescription drug costs paid by you and the plan in 2025.

Your participation is voluntary, and does not affect your coverage. The program is no cost to you and is open only to those who are invited to participate. The program is not a benefit for all plan members. Regardless of the criteria above, you may also be enrolled in the Wellcare By Fidelis Care program if you are an at-risk-beneficiary enrolled in our Drug Management Program.  

The program provides you with:

• a Annual Comprehensive Medication Review (CMR)
• a Written Summary
• a Quarterly Targeted Medication Review (TMR), and 
• Information on the safe disposal of prescription drugs

Annual Comprehensive Medication Review
The review is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:

• Prescription drugs
• Over-the-counter (OTC) medicines
• Herbal therapies
• Dietary supplements and vitamins

The pharmacist will offer ways to manage your conditions with the medications you take. If more information is needed, the pharmacist may contact your prescribing doctor. The review takes about 30 minutes and is usually offered once each year—if you qualify. At the end of your discussion, the pharmacist will provide you a Personal Medication List with the medications you discussed during your review.

You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

Written Summary
Within 14 days of the CMR, you will receive a standardized post CMR takeaway letter which includes a "Recommended To-Do List" detailing the conversation with the MTM provider, a Personal Medication List (PML), and may contain medication safe disposal information.

Quarterly Targeted Medication Review
With this review, we mail, fax or call your doctor with suggestions about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them. We may also contact you, by mail or phone, with suggestions about your medications.

Information on the safe disposal of prescription drugs

Information will be provided to help you safely dispose of unused prescription drugs that are controlled substances. This information will include details on drug take back programs, in-home disposal, and cost-effective means of safe disposal of such drugs.

You may receive a call from a pharmacy where you recently filled one or more of your prescriptions. You will be given the option to choose an in-person review or a phone review.

You may also be contacted by a call center pharmacist to provide your review, and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.

Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:

• Discuss how your prescription drugs and OTC medications may affect each other
• Identify any prescription drugs and OTC medications that may cause side effects, and offer suggestions to help
• Help you get the most benefit from all of your prescription drugs and OTC medications
• Review opportunities to help you reduce your prescription drug costs

• Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely
• The pharmacy can look for ways to help you save money on your out-of-pocket prescription drug costs
• You benefit by having a Personal Medication List and a Medication Action Plan to keep and share with your doctors and health care providers

If you would like to talk with a pharmacist about your medications, or if you do not want to participate after being enrolled into the program, please call Express Scripts toll-free at 1-855-931-2782 (TTY 711), Monday through Friday, 8 a.m. to 6 p.m. Central Standard Time (CST).

The Wellcare by Fidelis Care MTM Program is dedicated to providing you with information about safe medication disposal. Medications that are safe for you may not be safe for someone else. Unneeded medications should be disposed of as soon as possible. You can discard your unneeded medications through a local safe disposal program or at home for some medications. 

• Locating a community safe drug disposal site

A drug take back site is the best way to safely dispose of medications. To find drug take back sites near you, visit the website below and enter your location:

https://apps2.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e2s1
 (By clicking this link, you will leave the Fidelis Care website.) 

Some pharmacies and police stations offer on-site drop-off boxes, mail-back programs, and other ways for safe disposal. Call your pharmacy or local police department (non-emergency number) for disposal options near you.

• Mailing medications to accepting drug disposal sites

Medications may be mailed to authorized sites using approved packages. Information on mail-back sites can be found at www.deatakeback.com. (By clicking this link, you will leave the Fidelis Care website.) 

• Safe at-home medication disposal

You can safely dispose of many medications through the trash or by flushing them down the toilet. Visit the following website to learn more about safe at-home disposal:

https://www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html (By clicking this link, you will leave the Fidelis Care website.) 

Follow these steps for medication disposal in the trash:

• Remove medication labels to protect your personal information
• Mix medications with undesirable substances, such as dirt or used coffee grounds
• Place mixture in a sealed container, such as an empty margarine tub