Medication Therapy Management Provider Information

The University of Minnesota Health Plan (UPlan) invites pharmacists to join the UPlan MTM Provider Network to provide MTM services to eligible University employees and their dependents across Minnesota, and to employees 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 programs are: 
Delivering Medication Therapy Management Services (offered by APhA)
Pharmaceutical Care (offered by College of Pharmacy, Continuing Pharmacy Education)

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 currently taking four or more UPlan-covered prescription and over-the-counter medications for chronic conditions or are referred by their physician. A 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 points in the UPlan's Wellness Program. These points can be used toward a reduction on annual medical rates.

Note: There is no longer an enrollment form for UPlan MTM. To accumulate points toward a reduction in health care rates, the employee must participate in the UPlan's Wellness Program.

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 (pdf) lists the medications that are covered by the program.  

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

Back to top

State Employee Group Insurance Plan (SEGIP) MTM Diabetes Program

As of June 1, 2013, the UPlan MTM Network is providing MTM services for State of Minnesota employees with 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. Currently, spouses and covered dependents are not eligible for this program. 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 

Back to top