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Your Submission Has Been Received.‍

What's next?

After submitting the form, look out for an email from your designated SmithRx contact. They'll help you gather the right documents to get the repricing analysis started.

Once you send your claims history to the designated SmithRx contact, expect the custom report in 5-10 business days.

Next Steps

We'll be in touch soon to request a claims history. Get started by preparing a set of claims that include the following fields or use our Excel Template linked below:

Prepare the set of claims that include the following fields:

For SmithRx performance

  • Fill Date

  • NPI/NABP (Pharmacy location)

  • NDC

  • Quantity

  • Days Supply

  • Retail / Mail Indicator

  • Brand / Generic Indicator

For Savings Comparison

  • Ingredient Cost

  • Dispensing Fee

  • Plan Cost

  • Member Cost

  • AWP

  • Admin Fee

  • Rebate Figures

Download the Excel Template here in preparation for your correspondence with your SmithRx. contact.

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