Troubleshooting Pharmacy Coverage

If your pharmacy tells you that your prescription isn't covered or that you lack active coverage, don't panic. In most cases, this is caused by a simple error or a temporary processing issue rather than a loss of benefits.

Here are the most common reasons this happens and how to resolve it quickly.

Step 1: Ensure the Pharmacy Has Your SmithRx Coverage Information

Sana partners with SmithRx to manage prescription benefits. If the pharmacy attempts to bill Sana directly as medical insurance instead of SmithRx, the claim will be rejected.

Show your pharmacist the back of your Sana Member ID Card and verify they have entered the following information:

• RxBIN: 024368
• RxPCN: 3207
• RxGroup: This should match the group # on the front of your card.
• Member ID: (Your exact Member ID, and with or without the suffix)

Step 2: Check for Common Rejection Reasons

A rejected claim does not automatically mean the medication is denied permanently. Common reasons include:

• Prior Authorization Required: Certain medications require clinical review before coverage is approved.
• Step Therapy or Quantity Limits: The plan may require trying an alternative first or limit the quantity dispensed at one time.
• Refill Too Soon: The claim may be rejected if a previous fill is still within its expected usage window.

Step 3: Contact SmithRx Support for Immediate Assistance

If the pharmacy cannot resolve the rejection on-site, you or the pharmacist can contact SmithRx Member Services directly for real-time claim intervention:

• Phone: (844) 454-5201
• Email: help@smithrx.com

Hours: Monday–Friday: 7:00 a.m. – 8:00 p.m. CST | Saturday: 10:00 a.m. –3:00 p.m. CST