HealthSmartRx Medical Drug Copay Maximizer

Blue Cross is working with HealthSmartRx (HSRx), an independent company, to implement the HealthSmartRx Medical Drug Copay Maximizer program effective November 1, 2021. This program is currently only available to PEEHIP members. Other groups may add this program in 2022. 

The HSRx Copay Maximizer offers savings through copay assistance for PEEHIP members who are prescribed specific provider-administered specialty drugs. This copay assistance will ensure that these members continue to have access to these drugs at no cost, which can improve adherence and clinical outcomes. PEEHIP members are required to enroll in HSRx Copay Maximizer for medical benefit coverage of provider-administered drugs in scope for this program. 

Provider Responsibilities  

  • Check ProviderAccess Eligibility and Benefits or your practice management software to determine if HSRx Copay Maximizer Program participation and/or drug precertification is required for your patient. 
  • If required, initiate precertification through the pre-service review process. You will receive a letter if precertification is approved.
  • If your patient has not yet enrolled in the Copay Maximizer, enrollment materials are mailed to your eligible patient.  Subsequently, an HSRx Patient Advocate will reach out to your patient by phone to facilitate enrollment and answer any questions they may have. 
  • Your office may be contacted by HSRx for assistance in getting in touch with your patient for enrollment and/or to provide documentation required by the manufacturer for the copay assistance program.  Please note: You may not enroll on your patient’s behalf.  Your patient must speak to an HSRx Patient Advocate directly.  

Once your patient is enrolled, an HSRx Patient Advocate will contact your office to provide additional details including how you will receive copay assistance funds from the manufacturer.   

  • Additionally, look for a fax verification regarding your patient’s HSRx Copay Maximizer enrollment.  Once you receive notification, you may proceed with providing treatment.
  • Finally, submit a medical claim to Blue Cross for primary payment. 

If you have questions, email HSRx at FinancialAssistance@HealthSmart.com or call them
at 1-833-798-6733.

HealthSmartRx is an independent company that provides provider-administered drug copay maximization program management for Blue Cross and Blue Shield of Alabama.