pharmacy

CommunityCare Pharmacy Benefit

Information about Ascension St. John Tulsa's prescription drug plan included with your medical coverage is available through the CommunityCare website.

The CommunityCare website has more information about your medical plan as well as about the online CommunityCare Member Connection secure website, which contains information about your current benefits.

Use the contact information phone number, below for eligibility information.

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.

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
Glossary of Terms
Preventive 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.
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).
Maintenance drug list, effective 1/1/2022	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. Click here to transfer medications.
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 medication may increase and you may pay a higher amount out-of-pocket for your medication (click here for medical specialty medications). The Ascension SmartHealth Medical Plan has designed the SmartHealth Flexible Copay program to work with the manufacturer’s copay assistance program to help lower your out-of-pocket costs on your high-cost medications - and there is no cost to participate. To find out if you are eligible, call the SmartHealth Flexible Copay program at 1-833-980-2352, option 7, to get started.

For providers:

Provider-administered specialty medications or infusion therapies

All physician-administered specialty medications or infusion therapies will be subject to precertification notification or prior authorization (PA) approval. For a product list with current requirements, please see the Medical Specialty Drug List. In addition, medications and/or therapies subject to prior authorization approval are listed in the table below. The clinical criteria for each is also available for your review:

Medication(s) requiring PA	HCPCs	Date PA requirement effective
Aduhelm	J0172	1/1/2022
Blincyto	J9039	1/1/2022
Brineura	J0567	1/1/2022
Danyelza	J9348	1/1/2022
Folotyn	J9307	1/1/2022
Soliris	J1300	1/1/2022

Complete the following steps to submit a precertification notification or prior authorization request for a physician-administered specialty product or infusion therapy (Medical Specialty Drug List):

Download the appropriate form

Complete and sign the form
Submit the completed and signed form:

Via fax to 833-594-1875
Via email to smarthealthspecialty@ascension.org

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

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.