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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.

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Pharmacy

CommunityCare Pharmacy Benefit, effective through December 31, 2022

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.

Visit the CommunityCare website to learn more .

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

 

SmartHealth pharmacy benefit, beginning January 1, 2023

Ascension’s prescription drug plan is automatically included with your SmartHealth medical coverage. In 2023, Cigna will 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 2023. 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, 2022 and need prescriptions filled, you can continue to use your old card or download the 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. Please note: Pharmaceutical manufacturer patient assistance programs including copay cards, debit cards, and other forms of assistance do not count towards your annual out-of-pocket expense, or your annual deductible.

Benefits exclusion 2023
Paying directly for over-the-counter (OTC) versions of some heartburn, stomach acid, and allergy medications generally costs less than the set copay amount in our prescription plan, so these prescription medications will not be covered in 2023. You can use pre-tax dollars from your health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA) to cover these expenses. 

Proton Pump Inhibitors (e.g. Prilosec, Prevacid, Protonix, Dexilant, etc) and H2 Blockers (e.g. Pepcid, Zantac, Tagamet) used to treat heartburn, stomach ulcer, or stomach acid conditions are excluded. Oral 2nd generation allergy, eye allergy, and nasal allergy medications (e.g. Claritin, Clarinex, Zyrtec, Allegra, Pataday, Flonase, Nasonex, etc) are excluded. 

Effective 1/1/23, for prescriptions written for any of the medications or medication classes listed above, this will require the member to pay directly for the medication. These costs are not applied to annual deductible, nor annual out-of-pocket expense.

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.

Make the switch to Ascension Rx - get maintenance and specialty medications delivered to your door
Ascension Rx is the preferred pharmacy for SmartHealth members. To learn more, visit ascensionrx.com.

Please note: For outpatient specialty medications and flex copay drugs, Ascension Rx Specialty Pharmacy is the covered pharmacy for SmartHealth members. 

*SmartHealth Flexible Copay program

In 2023, 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 continuing the SmartHealth Flexible Copay program. This 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.

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. Click here to view FAQs.

Important pharmacy documents

Description

FAQs

SmartHealth Home Delivery FAQ

Frequently asked questions for SmartHealth members on Ascension Rx home delivery

Formulary list, effective 7/1/2022

Covered medications

2022 formulary changes

Glossary of Terms

Maintenance drug list, effective 7/1/2022 Maintenance medications are used to treat chronic, long-term conditions and are taken on a regular basis.

No cost (zero copay) preventative list (PPACA), effective 7/1/2022

Medications available at no cost to members under Patient Protection and Affordable Care Act (PPACA).

Preventative medication drug list, effective 7/1/22

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 hereto find an Ascension Rx pharmacy. Sign up for Ascension Rx online.

Ascension Rx exclusive specialty drug list, effective 9/1/2022

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 above.

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 pharmacy benefit

Ascension’s prescription drug plan is automatically included with your SmartHealth medical coverage. In 2023, 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 2023. 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, 2022 and need prescriptions filled, you can continue to use your old card or download the 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. Please note: Pharmaceutical manufacturer patient assistance programs including copay cards, debit cards, and other forms of assistance do not count towards your annual out-of-pocket expense, or your annual deductible.

Benefits exclusion 2023
Paying directly for over-the-counter (OTC) versions of some heartburn, stomach acid, and allergy medications generally costs less than the set copay amount in our prescription plan, so these prescription medications will not be covered in 2023. You can use pre-tax dollars from your health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA) to cover these expenses. 
 
Proton Pump Inhibitors (e.g. Prilosec, Prevacid, Protonix, Dexilant, etc) and H2 Blockers (e.g. Pepcid, Zantac, Tagamet) used to treat heartburn, stomach ulcer, or stomach acid conditions are excluded. Oral 2nd generation allergy, eye allergy, and nasal allergy medications (e.g. Claritin, Clarinex, Zyrtec, Allegra, Pataday, Flonase, Nasonex, etc) are excluded. 
 
Effective 1/1/23, for prescriptions written for any of the medications or medication classes listed above, this will require the member to pay directly for the medication. These costs are not applied to annual deductible, nor annual out-of-pocket expense.
  • 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.

Make the switch to Ascension Rx - get maintenance and specialty medications delivered to your door
Ascension Rx is the preferred pharmacy for SmartHealth members. To learn more, visit ascensionrx.com.

Please note: For outpatient specialty medications and flex copay drugs, Ascension Rx Specialty Pharmacy is the covered pharmacy for SmartHealth members. 

Important pharmacy documents

Description

FAQs

 

SmartHealth Home Delivery FAQ

Frequently asked questions for SmartHealth members on Ascension Rx home delivery

Formulary list, effective 7/1/2022

Covered medications

2022 formulary changes  

Glossary of Terms

 
 Maintenance drug list, effective 7/1/2022 Maintenance medications are used to treat chronic, long-term conditions and are taken on a regular basis.

No cost (zero copay) preventative list (PPACA), effective 7/1/2022

Medications available at no cost to members under Patient Protection and Affordable Care Act (PPACA).

Preventative medication drug list, effective 7/1/22

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 9/1/2022

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

In 2023, 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 continuing the SmartHealth Flexible Copay program. This 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.

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. Click here to view FAQs.

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 benefit 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 product or infusion therapy: 

1. Download the form: Medical benefit drug precertification notification and PA form (2022).

2. Complete and sign the form.

3. Submit the completed and signed form:

For questions about eligibility 
Contact Ascension HR Central 1-844-847-4747.

Hours of operation: 8 a.m.-6 p.m. EST, Monday-Friday.
For customer service support regarding the SmartHealth pharmacy plan, please call Cigna at 1-855-281-8312.

For questions about eligibility 
Contact Ascension HR Central 

Hours of operation: 8 a.m.-6 p.m. ET, Monday-Friday
For customer service support regarding the SmartHealth pharmacy plan, please call Cigna at: 1-855-281-8312
For members with HAP, please call: 1-844-813-3858

For Questions About Eligibility 
Contact Ascension HR Central  Call Toll-Free: 1-844-847-4747

Hours of Operation: 8 a.m.-6 p.m. ET, Mon.-Fri.
For customer service support regarding the SmartHealth Pharmacy plan, please call Cigna at: 1-855-281-8312