GENERIC SUBSTITUTION

If a brand name medication has a generic equivalent available, the pharmacy or mail order facility will automatically fill the prescription with a generic when the brand name is not medically necessary. If the physician or member requests to have a brand name medication dispensed when it is not medically necessary, the member will pay the difference in the cost of the brand and generic medication plus the generic co-pay. There is a Clinical Review Process through which it is possible to have a determination made as to whether or not a brand name drug is medically necessary. The member’s physician may contact customer service to initiate the review process*. If approved as medically necessary, the member will pay the brand co-pay. *Some restrictions apply.

MAIL ORDER PHARMACY SERVICE

Members may use the mail order pharmacy for their maintenance medications. A member can order a 90-day supply and have the convenience of having the medications shipped directly to their home (or alternate address) by paying the co-pays. Everything a member needs to place an order should be available at the district office or by calling Navitus customer service. Please note: Not all prescriptions can be filled by mail order.

WHAT IS A SPECIALTY MEDICATION?

Specialty medications are high-cost injectable, infused, oral, or inhaled medications that generally require special handling and may be subject to special rules such as quantity limits, prior authorization and/or step therapy. These medications have become a vital part of the treatment for chronic illnesses and complex diseases such as multiple sclerosis, rheumatoid arthritis and cancer. Some medications may involve special delivery and instructions that not all pharmacies can easily provide. These medications require personalized coordination between the member, the prescriber and pharmacy. Navitus Specialty helps patients stay on track with treatment while offering the highest standard of compassionate care through personalized support, free delivery and refill reminders. Most medications classified as Specialty can be found on the SISC Drug List located on Navitus secure member website Navi-Gate for Members at www.navitus.com.