Pharmacy Plan

Smith Rx

SmithRx is our new prescription benefit provider. SmithRx is dedicated to giving you the best service and resources to help you and your family make better healthcare decisions. For support, call (844) 454-5201 anytime.

Using Your Prescription Drug Card at Retail

You will receive a prescription card in the mail. Please present your new prescription card along with your prescription to any of the 67,000+ retail pharmacies every time you fill your
prescription.

Using Your Mail Order Home Delivery Benefit

Taking advantage of your home delivery benefit may enable you to receive up to a 90-day supply of your maintenance medication(s) at a discounted price through Serve You DirectRx. Just ask your physician to write a new prescription to Serve You DirectRx for home delivery. To get started you can ask your physician to:

  • E-prescribe or Fax: Have your doctor electronically prescribe or fax your prescription to (866) 494-0364. Faxed prescriptions may only be sent by a doctor’s office and must include patient information and diagnosis for timely processing.
  • Phone: Your doctor can “call-in” the prescription to (800) 759-3203 with an IVR option.
  • Please note: For prompt delivery, please provide your payment information by faxing or mailing in your completed Mail-in Order Form to PO Box 26096, Milwaukee, WI 53226 and calling (800) 759-3203.

Forms can be found on their website and below:

Online Tools

The secure online portal at www.mysmithrx.com protects your confidentiality and allows you to access:

  • Drug formulary
  • Real-time benefit information
  • View and download pharmacy claims
  • Claim reimbursement, prior authorization request, specialty pharmacy enrollment, and mail order forms

Formulary Changes

To help provide our customers with access to safe, high-quality, and cost-effective prescription benefits, it is necessary to classify some drugs as preferred and others as nonpreferred drugs on the SmithRx formulary.

Requirements for Coverage and Medication Limits

Your Plan may have additional requirements for coverage or limits for select prescription medications. These requirements and limits ensure that members use these medications in the most effective way and also help the Plan control medication costs. A team of practicing physicians and pharmacists developed these requirements and limits to help your Plan provide quality coverage to members.

  • Quantity Limits: For certain medications, your Plan may limit the amount of the medication that will be covered per prescription or for a defined period of time. Amounts exceeding these limits will require additional review for coverage.
  • Step Therapy: In some cases, your Plan requires you to first try one medication to treat your medical condition before it will cover another medication for that condition. For example, if Drug A and Drug B both treat your medical condition, your Plan may require your physician to prescribe Drug A first. If Drug A does not work for you, then your Plan will cover Drug B.
  • Prior Authorization: If your physician prescribes a medication requiring a prior authorization, you will need to go through an additional authorization process. Our Clinical Team reviews requests for these selected medications to help ensure the appropriate and safe use of medications for your medical condition(s). To see if your medication(s) require prior authorization, please contact Customer Service at (844) 454-5201.