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 Plan FAQ
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 created optional prescription drug insurance through Medicare. It is commonly referred to as Medicare Part D.
This drug coverage is available to everyone who is entitled to Medicare Part A benefits and/or enrolled in Medicare Part B, regardless of income, health status or how their prescriptions were previously covered. Private companies, like Smart Insurance Company, provide the insurance coverage; you choose the drug plan that works best for you.
Smart Insurance Company was formed to find innovative solutions that allow seniors and their caregivers to better understand and take advantage of the prescription drug coverage options in today’s health care marketplace.
Through an alliance with RxAlly and the more than 22,000 trusted RxAlly member pharmacies nationwide, Smart Insurance Company is positioned to play a significant role in shaping prescription solutions for seniors with
To be eligible for Medicare Part D prescription drug coverage, you must be entitled to Medicare Part A benefits and/or enrolled in Medicare Part B. You must also live within your Part D plan's service area and you must not be enrolled in more than one Part D plan.
SmartD Rx plans are offered in all 50 states, the District of Columbia and Puerto Rico. Either plan is welcome at more than 22,000 trusted neighborhood pharmacies in one of the nation's largest Preferred Networks.
SmartD Rx offers you a nationwide network of more than 22,000 preferred pharmacies. Our Preferred Network includes the RxAlly alliance of independent pharmacies, as well as national and regional chains.
SmartD Rx was developed with pharmacists who had the benefit of looking at the various plans that have been introduced since 2006.
We know how important it is not only to have your prescriptions filled, but have someone make sure you use your medications safely and effectively. We recognize the value of customized care plans and tools to make it easier for you to take and manage your prescriptions. We know how you appreciate the convenience of clinical services like immunizations and home delivery of your prescriptions.
That's why SmartD Rx emphasizes the valuable support and follow-through of your local community pharmacist. It's the best way we know to help you achieve better health and wellness.
The list of drugs, both brand-name and generic, that are covered by your
The SmartD Rx formulary covers all medications required by Medicare Part D and is approved by Centers for Medicare & Medicaid (CMS). However, not every drug brand will be covered on every plan formulary. See the SmartD Rx formulary for the prescription drugs covered by SmartD Rx plans. You can also use the "Drug Search" link at the top of the page to locate the formulary.
Under certain circumstances, you can ask SmartD Rx to make an exception and cover your drug. Click on the SmartD Rx formulary for more information on the exceptions and appeals process.
Yes, there may be changes to the formulary during the year that may affect which drugs are covered and how much you pay for your prescriptions. If you are using a drug that is affected by the change, you will receive a written notice of changes to the SmartD Rx formulary at least 60 days before the change will take effect. We will also post a Formulary Change Notice on this website.
If you don't see one of your drugs on the formulary, you can ask for an exception. Either you or your health care provider may initiate a request for a formulary exception. You may also write a letter to request a formulary exception. In order for SmartD Rx to make a formulary exception, we must receive a statement from your health care provider explaining why the medication is medically necessary for you.
Covered prescription drugs are broken into categories, or tiers, used to determine the cost of your copay or coinsurance. The amount you pay depends on which tier your drug is in. There are five copayment tiers for
- Tier 1: Preferred Generics (most generic drugs)
- Tier 2: Non-Preferred Generics (higher-cost generic drugs)
- Tier 3: Preferred Brand-Names (common brand-name drugs)
- Tier 4: Non-Preferred Brand-Names (higher cost brand-name drugs)
- Tier 5: Specialty Drugs (for complex or rare conditions)
Generic drugs are lower cost drugs with the same active ingredients as brand-name drugs for which the patent has expired. Generics must meet the same FDA quality and safety standards as brand-name drugs. Both the SmartD Rx Saver and SmartD Rx Plus plans offer no-cost and low-cost generic drugs to lower your out-of-pocket costs.
There is a Coverage Gap between $2,970 (a total of what you and the Plan have paid for covered drugs, not including the cost of premiums) and $4,750 in out-of-pocket costs (calculated as your deductible if you have one plus all copays/coinsurance paid during the Initial Coverage Period plus what you have paid for covered drugs during the Coverage Gap).
Here's what SmartD Rx Saver pays during the Coverage Gap:
- Brand-Name Drugs: 2.5% of costs are covered by the Plan and 50% of costs covered by pharmaceutical manufacturers. You pay only 47.5%. (Good news: The 50% covered by pharmaceutical manufacturers counts toward the $4,750 of your out-of-pocket spending.)
- Generic Drugs: 21% of costs are covered by the Plan. You pay 79%.
Here's what SmartD Rx Plus pays during the Coverage Gap:
- Tier 1 Preferred Generics: Covered at the same copays as during the Initial Coverage Period: $0 copays for Preferred Network pharmacies and $10 copays for Broad Network pharmacies.
- All Other Tiers: Covered at standard defined levels.
- Gap coverage continues until the $4,750 out-of-pocket limit is reached.
No. SmartD Rx will send you a new ID card that you should use whenever you get a prescription filled.