Medicare Advantage Part D pharmacy benefits

Female pharmacist talking with senior female while standing in front of shelves of pill bottles.

Medications can play a significant role in your health care. The following information from WellFirst Health — Provided by SSM Health Plan — will help guide your decisions about medications and answer questions about your Medicare pharmacy benefits.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week
  • The Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778
  • Your state Medicaid office.

Formulary (List of covered drugs)

Drugs with special requirements

Utilization management for prescription drugs

  • Some covered medications have additional requirements, such as a prior authorization requirement or limits on coverage. See the requirements and view our prior authorization forms.

Part D coverage determinations, exceptions, appeals and grievances

WellFIrst Advantage medical management

Pharmacy benefit guideline FAQ

Pharmacy transition process

  • Learn about our pharmacy transition process for prescription drug coverage when you are a new member to plan, a returning member, when you change locations of care, and other special circumstances.

Find a pharmacy

Vaccine coverage

Medication therapy management program

Drug overutilization review program

You can contact our Customer Care Center if you need additional information, including:

  • How we control the use of services and costs
  • The number of appeals and grievances filed by our members
  • A summary description of how we pay our doctors
  • A description of our financial condition, including a summary of our most recent audit statement

Questions? Contact us.

Senior man using phone and laptop in his living room.Members
Talk with our Customer Care Center at 1-877-301-3326 (TTY:711).
 
Not a member?
Talk with one of our Medicare sales reps at 1-833-551-0565 (TTY:711) You can also call to ask for information in alternate formats and languages. 

Mailing address

WellFirst Health — Provided by SSM Health Plan
PO Box 56099
Madison, WI 53705-9399
 
View our Medicare disclaimers.

H8019_wellfirsthealth.com
Updated 11/18/20