Member Support

Get in touch with our support team to assist with your account or plan.

Frequently Asked Questions

  • 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 or submit your information through the card request form.

  • 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 look up 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?

    On our mobile site, you can securely and easily manage new prescriptions. All of your member information is included in a handy electronic ID card.

  • 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.

  • 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 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.

Document and Forms

Utilization Management

MAC List Policy

State-Specific Prior Authorization Forms

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Partnering with SmithRx to provide transparent pharmacy benefits helps us deliver low-cost, high-quality care. Their pass-through model is the best way to ensure prescription drug pricing is fair.

Will Young
CEO at Sana Benefits

My loudest and most challenging group was handled perfectly in the first 30 days post-go-live by SmithRx. If it were up to me, I would put every one of my new groups with SmithRx.

Ken Mensio
Vice President at Risk Strategies

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client retention

1,200+

employers served

50%

potential RX savings