How your pharmacy plan works
SmartHealth offers comprehensive pharmacy benefits, administered through our partner, VytlOne.
Your prescription cost is based on the type of medication you use and where it’s filled.
- Generic: for these medications, you’ll pay a set fee (called a copay).
- Brand name: If you select these drugs (preferred or non-preferred), you’ll pay a percentage of the cost (called a coinsurance payment).
- Specialty: These medications require you to pay a copay.
- Diabetic Supplies: Your benefits include coverage for lancets, test strips and insulin.
You can also review your plan’s Schedule of Benefits and Summary of Benefits and Coverage.
Pharmacy out-of-pocket costs for 2026
View how each medication is covered based on the medication type and coverage tier.
This chart illustrates the costs associated with each medication Tier 2026 prescription costs
❯| Pharmacy | Formulary Description | Copay & Coinsurance Amounts | VytlOne Rx Tier Structure* |
|---|---|---|---|
| Ascension Rx 30-Day Supply | Generic | Up to $25 | Tier 1 |
| Preferred | 20% up to $100 max | Tier 2 | |
| Non-Preferred | 30% up to $175 max | Tier 3 | |
| Retail 30-Day Supply | Generic | Up to $35 | Tier 1 |
| Preferred | 25% up to $150 max | Tier 2 | |
| Non-Preferred | 35% up to $225 max | Tier 3 | |
| Ascension Rx 90-Day Supply | Generic | Up to $75 | Tier 1 |
| Preferred | 20% up to $300 max | Tier 2 | |
| Non-Preferred | 30% up to $525 max | Tier 3 | |
| Ascension Rx Home Delivery 90-Day Supply | Generic | Up to $40 | Tier 1 |
| Preferred | 20% up to $200 max | Tier 2 | |
| Non-Preferred | 30% up to $350 max | Tier 3 | |
| Ascension Rx Specialty 30-Day Supply | Generic | 40% up to $200 max | Tier 4 |
| Preferred | 40% up to $250 max | Tier 5 | |
| Non-Preferred | 40% up to $425 max | Tier 6 | |
*The VytlOne Online Drug Search tool provides Tier #'s for each medication.
Important information and resources
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ID Cards
A new pharmacy ID card will be sent to you for VytlOne's drug plan in the beginning of the year. Please note that this card is different from your medical card.
To fill prescriptions, you must use your new prescription ID card. If you need a new card, please call 888-492-6811 or download the Ascension One app to access a digital copy of your card.
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Generic medications
Generic medications are equivalent to brand-name drugs but are typically more affordable. They contain the same active ingredients and work in the same way, meeting the same quality and safety standards as their brand-name counterparts. Choosing generics can help reduce your prescription costs while providing the same therapeutic effects.
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Brand name medications (preferred and non-preferred)
These are sold by a drug company under a specific name or trademark that is protected by a patent.
Preferred versus non-preferred Often two brand-name drugs help treat the same problem, but one has been shown to be more cost or medically effective than the other. That more effective drug becomes a preferred drug, and the other becomes a non-preferred drug.
- Preferred drugs are often more affordable.
- Non-preferred drugs might be your best option when preferred drugs aren’t suitable or available.
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Maintenance medications
Maintenance medications are medications taken at home on a consistent schedule to treat chronic or long-term conditions. This may include oral, injectable, inhaled, ophthalmic and topical medications. Specialty medications are not considered maintenance medications within your pharmacy benefit. These two classifications have different definitions and requirements within SmartHealth. Learn more about maintenance medications including types of medications and where to fill here.
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Specialty Medications
A specialty medication is considered a high-cost drug used to treat complex conditions. These drugs are available from your pharmacy benefits, and are usually self-administered. Specialty medications are prescription drugs that are filled by a specialty pharmacy because they have requirements that can only be fulfilled within our Exclusive Specialty Pharmacy Network. Specialty medications meet or exceed a cost of $830 for a 30 days supply, require special handling, require additional patient education, and/or require clinical pharmacy intervention to ensure safe use of the specialty drug.
Specialty medications must be filled within our Exclusive Ascension Specialty Pharmacy network. Some medications may be subject to participation in the Flexible Copay program.*Information on the Flexible Copay program appears below on this website.
SmartHealth specialty prescription drugs are Tier 4, 5 and 6 on this online drug search tool.
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Diabetic medications and supplies
Ascension preferred diabetic medications and supplies receive a reduced copay when filled at an ARx pharmacy.
Medications: Novolog (additional may be added)
Supplies: T1 (preferred generic) & T2 (preferred brand)
Continuous Glucose Monitors: T2 (preferred brand) -
Continuous Glucose Monitors
Continuous glucose monitors (CGM) are important tools for tracking and managing diabetes. Your plan offers coverage for two CGM sensors under your pharmacy benefit: the Dexcom and Abbott FreeStyle Libre.
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Glossary of terms
Refer to this glossary for definitions of pharmacy and coverage terms.
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Manual claim form
This claim form can be used to request reimbursement of covered expenses paid out of pocket.
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2026 SmartHealth ACA ($0) Medication List
Medications available at no cost to members under Patient Protection and Affordable Care Act (PPACA).
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2026 SmartHealth HDHP Preventative Medication List
Preventive medications are used to help avoid disease and maintain health. For those members on a high deductible health plan (HDHP), before the deductible has been met, these medications will only be subject to copay/coinsurance and still apply towards out-of-pocket max. If your medication is not a maintenance medication on this list, continue to fill it at your local pharmacy.
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Prescription Refills and Preventing Oversupply
SmartHealth Flexible Copay Program
Every year, the cost for some specialty medications might change and go up, which means you could pay more out of pocket. To help with this, SmartHealth has the Flexible Copay program. This program works with drug manufacturers' copay assistance programs to help lower your out-of-pocket costs for these expensive medications throughout the year.
However, please note that manufacturer assistance is not applied towards meeting your annual deductible or out-of-pocket expenses. For HDHP & HDHP EPO plan members, once the HDHP deductible is met with eligible expenses (e.g. medical), the member will pay the standard prescription drug copays for their SmartHealth health plan.
Please note, manufacturer assistance programs may change, or end at any time during the year. If that happens, you'll need to pay the regular copay or cost for your prescription based on your SmartHealth plan. Keep in mind that this assistance is provided by the drug manufacturer, not by Ascension Rx or SmartHealth.
If you have a specialty prescription drug with a high copay and you have questions about the SmartHealth Flexible Copay program please email our Ascension Rx Flex Copay Team at askflexcopay@ascension.org with your questions, along with your member and prescription information.
Provider administered specialty medications or infusion therapies
(Your provider or physician's office must submit the prior authorization)
All physician-administered specialty medications or infusion therapies are subject to precertification notification or prior authorization (PA) approval. For a product list with current requirements, please see the medical benefit drug list.
Have questions?
- Call 833-980-2352 to speak to a member of the Ascension Rx prior authorization team.
- Call 888-492-6811 to confirm a patient's SmartHealth plan eligibility.
To submit a precertification notification or prior authorization request for a physician-administered product or infusion therapy:
1. Download the Medical benefit drug precertification notification and PA form.
2. Complete and sign the form
3. Submit the completed and signed form:
- Fax to 512-831-5499
OR
- Use the Jiva Provider Portal