Medication Therapy Management Provider Information

The University of Minnesota UPlan Medical Program (UPlan) invites pharmacists to join the UPlan MTM Provider Network to provide medication therapy management services to eligible University employees and their dependents and to state employees and their eligible dependents participating in the State of Minnesota SEGIP (State Employee Group Insurance Plan) Diabetes MTM Program. 

MTM providers are needed throughout the state of Minnesota.

Pharmacist Eligibility

Pharmacists are eligible to become MTM providers in the UPlan network if they graduated during or after 1996, or have completed an approved continuing education course.

Current approved program: 
Delivering Medication Therapy Management Services (offered by APhA)

Application to Join the UPlan MTM Provider Network

MTM Provider Application and Release Form (pdf)

Information for Network Provider

University of Minnesota UPlan MTM Program

UPlan Member Eligibility

UPlan members are eligible to participate in MTM services if they are (1) currently taking four or more UPlan-covered prescription and over-the-counter medications for chronic conditions or (2) referred by their physician or (3) have a diagnosis of diabetes, regardless of number of medications. A physician referral request form is available below.

Referral Request for Medication Therapy Management Services (pdf)

UPlan Wellness Program

UPlan members who participate in the MTM program have the opportunity to earn wellness points in the UPlan's Wellness Program. These points can be used toward a reduction on annual medical rates.

UPlan Formulary

Prime Therapeutics LLC is the Pharmacy Benefit Manager for UPlan prescription claims. Pharmacists enrolled as providers in the UPlan MTM Network should consult the UPlan drug formulary when making recommendations for changes in a patient's medication therapy. The current University of Minnesota UPlan Formulary lists the medications that are covered by the program.

UPlan Prior Authorization (PA), Step Therapy (ST) and Affordable Care Act (ACA) information

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State Employee Group Insurance Plan (SEGIP) MTM Diabetes Program

The UPlan MTM Network provides MTM services for State of Minnesota employees and their dependents over the age of 18  who have diabetes. Eligible employees receive invitations to enroll. However, all SEGIP employees with a diagnosis of diabetes are eligible for the program, and credentialed network pharmacists may enroll any employees who fits the criteria for participation. For more information on program eligibility see SEGIP FAQs (pdf). 

Links to State Website for SEGIP MTM Diabetes Program      

SEGIP MTM Diabetes Management Program Forms and Documents

SEGIP D5 Data Submission

SEGIP Member Information

SEGIP Member Disenrollment Form

Program Contacts

Julie Balthazor
MTM Benefit Program Coordinator

Office location:
B288 Mayo Memorial Building
420 Delaware Street S.E.
Minneapolis, MN 55455

Mailing address:
7-159 WDH 
308 Harvard Street S.E.
Minneapolis, MN 55455 

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