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Fill out the form if you have questions, would like to receive Medication Therapy Management services, or have been automatically enrolled and would like to opt out. If you decide to participate, a pharmacist will review all of your medications to make sure they are safe and effective at no additional cost to you. Learn more about Medicare Therapy Management and how the program works.

Note: If you opt out, we will not contact you for a medication review and your doctor will not receive recommendations from this program. You can re-enroll at any time. You also attest that you’re the designated beneficiary or a legally authorized representative upon form submission.

Need additional help?

Please call 715.631.7444 (TTY 1.855.931.4852) or toll-free at 1.855.931.5266.
We’re available from 8 am – 4 pm, Monday – Friday.