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.
A formulary is a list of covered drugs selected by our plan in consultation with a team of health care providers, that represents the prescription therapies believed to be a necessary part of a quality treatment program. Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a network pharmacy, and other plan rules are followed.
Our plan covers both brand name drugs and generic drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
The formulary may change during the year and is updated monthly.
Following is a list of recent changes that have been made to the formulary.
The following provides additional information about other plan rules and coverage criteria.
Enter the first few letters of the drug you wish to search. If the drug is covered, it will appear in table below the search. Select the drug from the list. You will be presented with the Tier and any Requirements or Limits that may be associated with the drug.
You should first contact Member Services at 1-888-328-0420 (TTY: 1-888-328-0419), 24 hours a day, 7 days a week and confirm that your drug is not covered. If you learn that we do not cover your drug, you have two options:
You can ask Member Services for a list of similar drugs that are covered. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered.
You can ask us to make an exception and cover your drug. There are several types of exceptions that you can ask us to make:
- You can ask us to cover your drug even if it is not on our formulary.
- You can ask us to waive coverage restrictions or limits on your drug.
- You can ask us to provide a higher level of coverage for your drug. This would lower the amount you must pay for your drug.
For more information and options that may be available to you if you disagree with our coverage rules,
click hereto see how you can file a grievance or appeal.
The formulary was last reviewed on 11/30/2013. No changes have been made since 07/01/2013.