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 retail / Mail order not available
Note: The above copays apply to PPO Plus (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.
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)
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.
If you have any questions about the SmithRx Sana Formulary, please call their dedicated customer service team at (844) 454-5201.