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.
SmartD Rx Member FAQ
If you receive a prescription order from your physician, present it along with your SmartD Rx ID card at the participating pharmacy of your choice. Once you receive your medication you will be asked to pay a co-payment as required by your program; the remainder of the cost of your prescription will be paid by your plan sponsor.
If your contact information or eligibility status changes, please call Member Services.
Please call Member Services to request a duplicate ID card. (1-888-328-0420), 24 hours a day, 7 days a week. (TTY: 1-888-328-0419)).
If you have recently used your ID card at a pharmacy, they may have your card information on file in their computer system. If that is the case, you will only need to present your prescription and your personal identification, such as a driver's license. If you are having any problems getting your prescription filled call Member Services. (1-888-328-0420), 24 hours a day, 7 days a week.
To find a network pharmacy, you can use the Pharmacy Directory. An updated pharmacy directory is available here or you can call Member Services. (1-888-328-0420), 24 hours a day, 7 days a week. (TTY: 1-888-328-0419)).
You may go to any of our network pharmacies. However, you will usually pay less for your covered drugs if you use a Preferred Network pharmacy rather than a Non-Preferred Network pharmacy. The Pharmacy Directory will tell you which of the pharmacies in our network are Preferred Network pharmacies.
To find out if your medication is covered you can refer to the Formulary. An updated version is available here, or you can call Member Services. (1-888-328-0420), 24 hours a day, 7 days a week.
You must use a network pharmacy to receive plan benefits. We will not pay for your prescriptions if you use an out-of-network pharmacy, except in certain cases. Should you need to go to a non-participating pharmacy call Member Services first.
In the event you do use an out-of-network pharmacy you may submit a Claim Form along with an itemized receipt. Forms are available to download and print here or you can call Member Services at
A brand name drug is a prescription drug manufactured and marketed under a trademark by a specific drug manufacturer. It is the proprietary or patent protected product usually available from only one manufacturer.
A generic medication is a prescription drug that has the same active ingredients as a brand name drug. Generic drugs usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA) as safe and effective.
A multisource drug is a brand name drug whose patent has expired and for which generic drug equivalents are available on the market.
Certain medications in your program may require a prior authorization. You or your physician may need to provide additional information to make the determination 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.
When lower cost, alternative medications are available to treat your condition, you may be required to try an alternative drug 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.
Some medications have 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 to 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.
You can download and print the Authorized Representative form here to complete and mail back to us along with any applicable documentation that is required or you can call Member Services.
If you have a power of attorney that assists you in making general healthcare decisions, you can let us know by calling Member Services and receiving information about sending in such paperwork based on the rules of your state.
Medicare provides Extra Help to pay prescription drug costs for people who have limited income and resources. If you qualify, you receive help paying for any Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments or coinsurance. This Extra Help also counts toward your out-of-pocket costs. You must continue to pay your Medicare Part B premium.
Some people automatically qualify for Extra Help and don't need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.
To see if you qualify for getting Extra Help, call:
- 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048 , 24 hours a day, 7 days a week; - The Social Security Office at 1-800-772-1213, between 7 am to 7 pm, Monday through Friday. TTY users should call 1-800-325-0778; or
- Your State Medicaid Office.
Click herefor a list of State Medicaid Offices.
SmartD Rx is contracted with the Centers for Medicare & Medicaid Services (CMS), the government agency that administers Medicare. This contract is subject to renewal each year. However, the SmartD Rx or CMS can decide to end the contract at any time. You will be notified in writing up to 90 days in advance if the contract is discontinued. However, your advance notice may be as little as 30 days or fewer if CMS discontinues the contract during a plan year.
