SmartHealth Pharmacy Benefit

Ascension’s prescription drug plan is automatically included with your SmartHealth medical coverage. In 2022, Cigna will continue to be your pharmacy benefit provider.

Important pharmacy benefit and ID card information

A new pharmacy ID card will be sent to you for Cigna's drug plan in 2022. Please note that this card is different from your medical card. To fill prescriptions, you must use your prescription ID card.

If you haven’t received your new card by December 31, 2021 and need prescriptions filled, you can continue to use your old card or download the new SmartHealth app to access a digital copy of your card.

Pharmacy out-of-pocket costs

Rx Costs with the HDHP 3000/0

If you choose the high deductible health plan—the HDHP 3000/0—you pay the full cost of prescriptions until you meet your deductible ($3,000 individual/$6,000 family). Once you reach your deductible, your prescriptions are covered 100% for the remainder of the year.

If you are an associate at Our Lady of Peace, please click here to view your pharmacy out-of-pocket costs

Socially Just Benefits

If you are a member in a Socially Just Benefits plan, please click here to view your pharmacy out-of-pocket costs.

Switch to Ascension Rx to avoid paying the full cost out of pocket for specialty and maintenance prescriptions

The pharmacy benefit coverage is changing for SmartHealth members for specialty and maintenance prescriptions. Switch these medications to Ascension Rx today to avoid paying the full cost out of pocket. After January 1, 2022, these medications will only be a covered benefit when filled by Ascension Rx.

Important pharmacy documents	Description
FAQs
SmartHealth Home Delivery FAQ	Frequently Asked Questions for SmartHealth members on Ascension Rx Home Delivery
Formulary list, effective 1/1/2022	Covered medications
2022 formulary changes
Glossary of Terms
Maintenance drug list, effective 1/1/2022	Maintenance medications are used to treat chronic, long-term conditions and are taken on a regular basis. These medications must be filled at an Ascension Rx pharmacy.
Maintenance drug list, effective 7/1/2022
No cost share (zero copay) preventive list (PPACA), effective 1/1/2022	Medications available at no cost to members under Patient Protection and Affordable Care Act (PPACA).
Preventive Medication drug list, effective 1/1/22	Preventive medications are used to help avoid disease and maintain health. For those members on a high deductible health plan (HDHP), before the deductible has been met, these medications will only be subject to copay/coinsurance and still apply towards out-of-pocket max. If your medication is not a maintenance medication on this list, continue to fill it at your local pharmacy.
Ascension Rx pharmacies	Click here to find an Ascension Rx pharmacy. Sign up for Ascension Rx online.
Ascension Rx exclusive Specialty drug list, effective 1/1/2022	Specialty medications that must be filled at Ascension Rx Specialty Pharmacy. Some medications may be subject to participation in the Flexible Copay program. *Information on program below.
Manual claim form	This claim form can be used to request reimbursement of covered expenses paid out of pocket.
Continuous glucose monitors	Continuous Glucose monitors (CGM) are important tools for tracking and managing diabetes. Your plan offers coverage for two CGM sensors under your pharmacy benefit: the Dexcom G6^® and Abbott FreeStyle Libre.
Diabetic benefit	Ascension preferred diabetic medications and supplies receive a reduced copay when filled at an ARx pharmacy. Medications: Novolog (additional may be added) Supplies: T1 (preferred generic) & T2 (preferred brand) Continuous Glucose Monitors: T2 (preferred brand)

*SmartHealth Flexible Copay program

Starting January 1, 2022, the cost-share for some specialty medications may increase, which could result in higher out-of-pocket costs. Because Smart Health is committed to ensuring our members receive the lowest out-of-pocket cost on these high-cost medications, we are pleased to introduce the new SmartHealth Flexible Copay program. This new benefit program works with drug manufacturer’s copay assistance programs to provide the lowest out of pocket cost to SmartHealth members who need these medications. There is no cost to participate.

If you have a high copay and would like to find out if you are eligible, call the SmartHealth Flexible Copay program at 1-833-980-2352 and select option 7 to get started.

Provider administered specialty medications or infusion therapies
(Your provider or physician's office must submit the prior authorization)

All physician-administered specialty medications or infusion therapies are subject to precertification notification or prior authorization (PA) approval. For a product list with current requirements, please see the medical specialty drug list. The file includes two lists:

1. Precert + PA: Complete list

2. PA required: List of products requiring PA - includes a link using Brand Name to prior authorization clinical criteria for use documents

With questions:

Call 833-594-1845 to hear a recorded message which answers many frequently asked questions
Call 833-980-2352 to speak to a member of the Ascension Rx prior authorization team
Call 888-492-6811 to confirm a patient’s SmartHealth Plan eligibility

To submit a precertification notification or prior authorization request for a physician-administered specialty product or infusion therapy:

Download the appropriate form
- Single Product SmartHealth Precertification Notification and PA form (2022)
- Oncology or Complex Regimen SmartHealth Precertification Notification and PA form (2022)
Complete and sign the form
Submit the completed and signed form:
- Via fax to 833-594-1875
- Via email to smarthealthspecialty@ascension.org

Welcome to SmartHealth

SmartHealth is the medical plan for Ascension associates and eligible dependents. We help our members navigate their healthcare needs with ease and achieve positive health outcomes.

Choose your preferred Ministry by selecting it from the drop-down menu. You can change your preferred Ministry at any time.

Pharmacy

CommunityCare Pharmacy Benefit

SmartHealth Pharmacy Benefit

Keeping Healthy

Resources

Contact Us

Welcome to SmartHealth SmartHealth is the medical plan for Ascension associates and eligible dependents. We help our members navigate their healthcare needs with ease and achieve positive health outcomes.

Choose your preferred Ministry by selecting it from the drop-down menu. You can change your preferred Ministry at any time.

Pharmacy

CommunityCare Pharmacy Benefit

SmartHealth Pharmacy Benefit

Welcome to SmartHealth

SmartHealth is the medical plan for Ascension associates and eligible dependents. We help our members navigate their healthcare needs with ease and achieve positive health outcomes.