SmartD Rx (PDP) is not currently accepting enrollments due to CMS sanction action.
CMS has suspended all marketing and enrollment activities for SmartD Rx as of April 23, 2013.
Clinical programs focus on your health care and help to keep you safe. The following are some of the clinical programs in place to help manage your prescription drug use:
Drug Utilization Review
Drug Utilization Review is a potentially life-saving analysis of your medications that takes place electronically at the pharmacy in a matter of seconds. Our claim processing system has numerous clinical checks which are used to review the medication your pharmacist has submitted to be filled compared with your medication history and other key points of interest such as your age and gender.
During the drug utilization review our system also returns any restrictions on the coverage. These include:
Prior Authorization
Prior Authorization may be required to determine if the medication is covered under the plan. You or your physician may need to provide additional information before you may get your prescription filled. If you do not get approval, we may not cover the medication and you will be responsible for the full cost of the drug.
Step Therapy
When lower cost, alternative medications are available to treat your condition, you may be required to try an alternative drug to treat your condition before your prescribed medication may be covered. If you have tried other medications and you and your prescriber do not think the other medications are right for your situation, you may request that this medication be covered.
Drug Quantity Management
Drug Quantity Management or drug quantity limits apply to some medications with a restriction or a limit to the number of doses that may be covered for a specific day supply. Quantity limits are for your own safety and ensure proper use of the drug. If your prescriber requests a quantity greater than the specific limit, you may request an authorization for the plan to cover the prescribed amount.
Medication Therapy Management Program (MTM)
The Medication Therapy Management program provides information and support to help you get the positive results you expect from your medications and to help improve your quality of life. This program is designed to reduce any unwanted side effects that may, for example, occur as a result of using certain medications at the same time, and improve your medication compliance.
The program will provide you with a personal medication list, a medication action plan for improvement of care, recommendations for self-monitoring, and other relevant educational items.
If you take medications for specific chronic conditions, you may be invited to participate in the program.
Who is eligible to participate in the MTM Program?
An eligible beneficiary must have at least three chronic disease states, including:
- Chronic Heart Failure
- Diabetes
- Dyslipidemia
- Hypertension
- Respiratory Disease (Chronic Obstructive Pulmonary Disease)
A beneficiary's claims history must also have at least eight maintenance medications covered by Medicare Part D.
A beneficiary must be likely to incur annual costs of at least $3,144 for chronic/maintenance-type covered Part D medications.
If you participate in the program, here is what you can expect:
Welcome letter - A letter which explains the program is sent to you and your physician to help coordinate care.
Education - Newsletters will be provided that will discuss the proper use of medications and will include helpful hints about your disease state to improve your understanding of the condition.
Counseling - Clinical pharmacists will reach out to you to discuss your medications and any issues you may be experiencing. They will also be able to answer any questions you may have.
Comprehensive Medication Reviews - Surveys will be conducted to review your medication use and to make sure that you are getting the expected results from your medication. The survey will also confirm there are not any hidden issues you may be experiencing as a result of your medication. We will work with you and your healthcare provider to address any areas of concern or unwanted side effects you may be dealing with. We will also discuss all of your prescription medication as well as any over-the-counter (OTC) and herbal products you may be taking.
For additional information about any of our clinical programs please call Member Services at 1-888-328-0420, 24 hours a day, 7 days a week.
The MTM program or other clinical programs are not considered a benefit.
