Real-time pharmacy benefits
A clear view of your patients' coverage, instantly.
SmartyRx delivers patient-specific coverage, cost, alternatives, and prior authorization status in real time, so prescribers, pharmacies, and patients see the full benefit picture before a claim is ever processed.
SmartyRx brings efficiency to the provider and patient experience, giving physicians and pharmacies a transparent view of each patient's coverage.
Most prescribing decisions happen without the data that matters.
Coverage is unknown until the pharmacy fills
Prescribers write scripts based on best guesses about coverage. Patients discover problems at the counter, when changing course is harder, slower, and more expensive.
Prior auth shows up too late
When PA requirements surface at the pharmacy, the patient is already there. The script gets stuck. Office staff get the call. Therapy gets delayed.
Alternatives aren't visible
A cheaper covered option might exist on formulary, but no one sees it until the original prescription bounces. Then the cycle starts over with a new script.
The data exists. The problem is timing.
Wherever the prescription decision is made.
Prescribers and EHR systems
Patient-specific coverage and cost surfaced inside the prescribing workflow, so the decision happens with full information, not after the fact.
Pharmacies and pharmacy systems
Benefit detail available before the fill is attempted, reducing rework, callbacks, and abandoned prescriptions at the counter.
Health plans and PBMs
Real-time response infrastructure that aligns with payer benefit data and reduces the operational load of downstream PA submissions and claim rejections.
Three questions, answered before the script is written.
Is it covered?
Formulary status, copay, coinsurance, and deductible.
Is there a cheaper option?
Therapeutic alternatives with cost and approved pharmacies.
Will it need prior auth?
PA requirements, criteria, restrictions, and limits.
Real-time, patient-specific, before the pharmacy ever processes a claim.
A complete benefit picture, in one response.
Every SmartyRx response is patient-specific and pharmacy-specific, not an algorithmic estimate. The data comes back grouped into the categories that matter at the point of decision.
Coverage
- Formulary status
- Cost-sharing: copay, coinsurance, deductible
- Coverage limitations and quantity limits
Alternatives
- Up to three therapeutic alternatives with cost
- Approved pharmacies for each alternative
- PA requirements for alternatives, if any
Action signals
- Prior authorization requirements and criteria
- Step therapy requirements
- Clinical alerts and plan-specific messages
Returned in real time. Specific to this patient, this drug, this pharmacy.
Real benefit data. Not algorithmic estimates.
Legacy test claim (B1 / B2)
- Algorithm-based response
- Not patient-specific
- Not pharmacy-specific
- Workflow uncertain, used variably across systems
- An aging model the industry is moving away from
SmartyRx
- Real benefit data, returned in real time
- Patient-specific and pharmacy-specific
- Comprehensive: coverage, cost, alternatives, PA, and clinical signals in one response
- Built for the workflows prescribers and pharmacies actually use
Test claims tell you what a claim might look like. SmartyRx tells you what it will look like.
Built to improve your existing systems.
EHR and e-prescribing workflows
SmartyRx responses surface inside the prescribing tools clinicians already use. No separate portal, no additional login, no workflow disruption.
Pharmacy system integration
Pharmacies receive benefit detail in the systems they use for intake and adjudication, reducing manual benefit checks and callbacks.
See SmartyRx in action.
A walkthrough of how SmartyRx returns patient-specific benefit detail, including coverage confirmations, prior authorization triggers, lower-cost alternatives, and the messages prescribers and pharmacies actually need at the point of decision.