Pharmacy Benefits

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.

 

You can still fill your maintenance medications at any non-Ascension pharmacy of your choosing, but you will have to cover the full cost of the medication. 

Switching to Ascension Rx, your lowest cost option, ensures you continue to pay a low copay and enjoy all the benefits of Ascension Rx including the option of free delivery to your front door.

Maintenance medications are long term medications that are taken on a regular basis, often every day and they can treat a wide range of on-going or chronic conditions and illnesses such as high blood pressure, diabetes, allergies or asthma. Ascension Rx offers home delivery services on certain maintenance medications in 90-day supplies. 

Outpatient specialty prescription medications must be filled by Ascension Rx Specialty Pharmacy to avoid paying the full out-of-pocket cost.

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, Smart Health will continue offering the SmartHealth Flexible Copay program. This program works with drug manufacturers' copay assistance programs to help lower your out-of-pocket costs for these expensive medications.

However, manufacturer assistance programs may change or end at any time during the year. If that happens, you'll need to pay the regular copay 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 high copay and would like to find out if you are eligible, call the SmartHealth Flexible Copay program at 833-980-2352 and select option 7 to get started. Click here to view FAQs.

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