P.O. Box 77864
San Francisco, CA 94107
I lost or didn’t receive my ID card, how do I get a new one?
We are here to help, and can provide all the information you need to take your prescription to the pharmacy to be filled. Log on to your member portal for quick access to the information and instructions or call SmithRx at (844) 454-5201.
How do I manage my account online?
You can register for a secure SmithRx account at: https://mysmithrx.com/. From the member portal, you can lookup medications and see the copay tier. Members can find in-network pharmacies from our national network of over 68,000 participating locations. You can download mail order and prior authorization forms, review claims and find employer specific customer service contact information for any of your pharmacy service needs.
Is there an app available for my phone?
The SmithRx mobile site uses responsive technology based on what mobile device you prefer. It affords secure and easy access to manage new prescriptions and research in-network pharmacies with all of your member information handy with an electronic id card. You also can track claims history and contact our member support team via an employer specific toll free number. Plus, members can opt in for text (SMS) communications and alerts.
How do I get reimbursed for prescriptions paid for out of pocket?
Sometimes you can’t use your pharmacy benefits when you’re at the pharmacy. If that happens, you can download the reimbursement form from your member portal account and submit to us and we’ll help you get your money back. Don’t worry, if you’re not registered, you also can call our customer support team at (844) 454-5201 and we can email the form to you and answer any questions about the process. Reimbursement for these prescriptions will be based on your benefit plan design.
I don't understand the difference between Generic, Preferred Brand and Non-Preferred Brand drugs. Please explain.
Generic, Preferred Brand, and Non-Preferred Brand drugs are formulary classifications according to your plan design, which correspond to what is also known as Tiers (Tier 1 through Tier 3). Copay, in addition to other factors such as day supply of the prescription, is determined by the drug’s tier. Many medicines exist in different forms, most commonly in a generic form and one or many brand names. Equivalent brand vs. generic drugs are essentially the same because they have the same active ingredient, but the brand name drugs are generally more expensive. The formulary may designate certain brands as Preferred on Non-Preferred Brand drugs, with Non-Preferred Brand name drugs (Tier 3) generally having a higher copay than Preferred Brand name drugs (Tier 2).
What is “Step Therapy”? I didn’t sign up for hiking.
Step Therapy is a formulary condition in which certain drugs (medications designated as step therapy drugs by plan design) require other medication therapies to be tried before they can be covered by insurance. Step Therapy may have one or more levels of criteria (steps) that must first be fulfilled. If your doctor prescribes, or wants to prescribe, a medication that requires step therapy, he/she can call (844) 512-3030 to work with our clinical team to coordinate therapy and determine what is needed.
What are “Quantity Limits”?
Quantity Limits are formulary conditions for select medicines, as determined by plan design, that specify a maximum dosage or quantity that will be covered (for example, a maximum number of tablets per day). These quantity limits often reflect usual safe and effective doses for given medication therapies. Any dosing (reflected in quantity per day) up to the quantity limit will be covered, but dosing quantities above the quantity limit will be initially rejected. In order for any prescription exceeding a formulary quantity limit to be covered, the prescribing doctor will need to apply for a prior authorization, providing medical justification for the higher dosing to be reviewed by our clinical team.
I’m on vacation and my child forgot their medication, how can I get an urgent replacement?
If you are on vacation and are in need of medication (because medicine was forgotten or you ran out of medicine while away), there are a number of options depending on where you are vacationing and what medicine(s) you need. Many times, the best and most efficient solution is to have a pharmacy near you contact the pharmacy where you normally fill prescriptions to transfer the prescription to refill there. If it is too soon to refill, in order to avoid running out of medicine, you can call our customer service number at (844) 454-5201, and we can work with you to find a solution appropriate for your situation, taking into accounts any limits to timing, location, and specific medication therapy.
If my medication is not covered by SmithRx, what steps do I need to take?
You can call our member support team and we can review options on a case by case basis, working with your provider to coordinate care.
Is mail-order right for me?
Mail-order is a great solution for patients taking long-term prescriptions or simply prefer the convenience of having their prescriptions delivered. Patients on insulin or other temperature/shipping-sensitive medications also benefit from mail-order, but should consult their doctor to ensure their medication is still effective when shipped. Depending on your plan, you may save money by using the mail-order pharmacy. Sign-on to your member portal or call SmithRx at (844) 454-5201 for assistance with transitioning your retail pharmacy prescription to mail order.
What is Auto-Fill? How do I use it?
Auto-fill (or auto-refill) is a convenient and time-saving option for most of your mail order prescriptions. Opting-in for auto-refill may allow you better manage and maintain consistency for your medications, helping you to make the most out of the therapy prescribed to you. As such, it is a great option for chronic medicines that you take regularly and are important to take consistently. For medicines not on auto-refill, you would need to order each refill, requiring you to plan and call early to allow enough time before you run out of medicine. For prescriptions on auto-refill, instead of contacting the mail order pharmacy each time you need a refill, the medicine is automatically refilled and delivered to you according to your prescription schedule.
To place a prescription on auto-refill, you will need to call your plan’s mail-order pharmacy to opt-in for each prescription that you would like on auto-refill. If at any time your doctor stops a medicine that was on auto-refill, please call the mail order pharmacy to let them know that you are no longer taking this medicine to avoid being charged and sent medicine you no longer need.
How do I enroll in mail-order?
Step One: Talk to your doctor about getting a 90-day prescription for your medication. In most cases, this doesn’t require another visit to the doctor. Have your doctor send the prescription directly to the contracted mail-order pharmacy either electronically or by fax.
Step Two: Complete a mail order enrollment form. The form can be downloaded and printed from the member portal (under Documents and Forms) or you can call your employer-specific SmithRx customer service at (844) 454-5201. A member of our team can send you the form, provide instructions, and help answer any questions. Once the enrollment form is complete, mail the form to the mail order pharmacy at the address indicated.
Step Three: For questions on mail order prescriptions or to check the status of a delivery, please call the mail order pharmacy directly. If you have trouble contacting the mail order pharmacy, need their phone number, or need help with another matter, you can call our customer service number and we can to coordinate with the mail order pharmacy and work with you to find the most appropriate way to address any issues.
How do I check the status of my mail-order prescription?
Filling and delivery of mail order prescriptions, both new and refilled prescriptions, are managed by the mail order pharmacy contracted with your insurance plan. For the most up-to-date status of a mail-order prescription or delivery, you can call the mail order pharmacy directly. If you have any trouble calling the mail order pharmacy, you can also call our customer service number and a member of our team can coordinate with the mail order pharmacy to help you with a status update.
How do I submit prior authorizations?
If a prescription requires a prior authorization, the prescriber will need to complete a Request for Prior Authorization Form and mail or fax it back to us. Members can download/print this form off of the Portal (the prior authorization request PDF under Documents & Forms) to take to their doctor or the doctor can access it themselves via the CoverMyMeds site, but it is preferable for us to contact the prescriber to send it to them directly via fax or email.
How do I submit mail order prescriptions?
Just call the SmithRx provider number at (844) 512-3030 for assistance with transitioning a member’s retail pharmacy prescription to mail order.
How do I set up speciality drug orders?
If you need to prescribe, a medication that requires step therapy, providers can call (844) 512-3030 to work with our clinical team to coordinate therapy and determine what is needed.
What do I do if a claim rejects?
Please call our dedicated pharmacist line at (844) 512-3030 and our support specialists will work with you on resolving the rejection code. In many cases we will proactively call you when we see these in real-time and find the solution.
What if I can’t confirm the member’s eligibility?
No problem, contact us at (844) 512-3030 - our team can review the rejected claim with you and make sure member validation and plan entry details are correct. When a valid claim rejects and we are unable to make an immediate correction to allow adjudication of the claim, the patient may pay for the script and have it resubmitted once the eligibility has been corrected. The pharmacy will refund the patient the correct out of pocket amount.
Is SmithRx a full replacement for our current Pharmacy Benefit Provider?
SmithRx affords plan sponsors a full replacement Pharmacy Benefits Manager that reduces the workload of HR teams during implementation, Open Enrollment, and through each plan year iteration. Our account managers and customer service teams understand eligibility and claims adjudication processes. They resolve issues and identify trends through data analysis, offering proactive solutions to reduce member and HR issues.
All of our health benefits are bundled through our TPA that covers dental, vision, medical, and dental - can I still have SmithRx manage my pharmacy benefits?
Yes, innovative plan sponsors frequently work with their third party administrator to change pharmacy benefits managers to improve therapeutic quality while reducing employer and employee costs.
How long does it usually take to transition from my current PBM to SmithRx? Will there be a gap in my employees’ benefits?
Continuity of care and benefits is a high priority for SmithRx. We will work closely with you to make the transition seamless by providing a comprehensive implementation plan to help you through the process. We have done this in under two weeks.
SmithRx seems to offer a lot of customization, but what if I prefer a hands-off approach?
SmithRx has a standard benefits plan that has successfully been implemented for clients who want a simple design that delivers the highest therapeutic results along with consistent financial predictions based on de-identified data comparisons. This basic plan model can be customized at any time based on the client’s business needs.