SmithRx Formulary: Understanding Drug Coverage and Pricing

Did you know you can check out the coverage and costs of every prescription drug on your plan at a glance? This convenient document is called a formulary and it’s available here!

Every medication in your formulary is assigned a tier, which indicates pricing.

Medication Tiers and Pricing

Tier 1 – Generics: $10 retail / $20 mail order (three month supply)

Tier 2 – Preferred Brands: $30 retail / $60 mail order (three month supply)

Tier 3 – Non-Preferred Brands: $55 retail / $110 mail order (three month supply)

Specialty – $55 or $200 retail depending on your Plan / Mail order not available

• All items marked "ACA" (Affordable Care Act) in the formulary are no-cost, regardless of plan type.
• The above copays apply to PPO Plus (C, S, P, B, and E) plans.
• Members of PPO Plus HSA (H and HD) plans will owe the full cost of non-preventive medications prior to meeting their deductible, and can reach out to SmithRx for an estimate of their pre-deductible drug costs.

Helpful Hints

• Use control + f or command + f to find a drug name quickly.
• You’ll always pay the lowest copay when you choose the generic option. When clinically appropriate, please consider talking to your doctor about choosing a generic product.
• Some drugs (like weight loss or hair loss drugs) may be listed on the formulary but excluded from your plan per the Summary Plan Description (SPD). 
• The formulary does not guarantee coverage. Coverage will vary per the SPD.
• Sign in to your account to view your SPD under Documents. 

Formulary Definitions

Quantity Limits: The maximum covered medication per prescription or defined period of time

Step Therapy: When your plan requires you to first try one medication to treat your medical condition before it will cover another medication for that condition

Prior Authorizations: An additional authorization process conducted by the SmithRx Clinical Team, which is required for certain prescriptions to help ensure the appropriate and safe use of medications for your medical condition(s)

Please note:

• Urgent requests may take up to 72 hours.
• Standard requests may take up to 15 days.

How SmithRx determines its formulary

SmithRx has a Pharmacy and Therapeutics Committee (P&T) and a Value Assessment Committee (VAC) dedicated to conducting clinical evaluations to determine safety and efficacy based on the peer-reviewed literature and medical care guidelines of each drug in the formulary. These committees then weigh the financial implications of a drug compared to other similar drugs and determine the appropriate tier placement based on the drugs’ safety, efficacy, and cost-effectiveness.

Formularies are updated quarterly, so always check back for current coverage and pricing. This list can change over time, and coverage may vary based on your specific plan design. For the most accurate, up-to-date information about the SmithRx Sana Formulary, please contact their dedicated customer service team at (844) 454-5201.