Navitus

Navitus Health Solutions is your Pharmacy Benefits Manager (PBM). A PBM directs prescription drug programs by processing prescription claims.

Information about your pharmacy benefit can be found on www.navitus.com  through the member portal, Navi-Gate for Members. You can also call Navitus Customer Care toll-free at 866-333-2757 with questions about your pharmacy benefit.

Your health comes first, and Navi-Gate can help you with your pharmacy benefit questions and more. Navi-Gate for Members provides you with online access to a wealth of information to help you better understand your prescription drug benefits, add convenience to your life and help identify cost-saving options. Whether it is helping you find a local pharmacy or reviewing your medication profile, Navi- Gate will provide you with the information to take control of your personal health. You can sign up for Navi­ Gate for Members by doing the following:

1. Call Navitus Customer Care at 866-333-2757 to get your member ID (that is different than what is printed on your ID card).
2. Go to www.navitus.com, click on the Members tab   and   select   "Member Login."
3. Select "Click here for new registrations."
4. Enter the member ID. Select a password of your choice, using the requirements listed. Continue with the registration process.

NOTE: Due to government regulations concerning disclosure of protected personal health information, all members age 12 and older must register to obtain their own user ID and password.

Your prescription can be refilled when approximately two-thirds or 70% of the prescription has been taken. Some restrictions apply.

If you are traveling for less than one month, any Navitus Network Pharmacy can arrange in advance for you to take an extra one-month supply. A copay will apply.

If you are traveling for more than one month, you can request that your pharmacy transfer your prescription order to another network pharmacy located in the area where you will be traveling.

Visit www.navitus.com for instructions on filling prescriptions while traveling. Or contact Customer Care toll-free at 866-333-2757.

Prescriptions cannot legally be mailed from any pharmacy in the United States, to places located outside of the country. The only exceptions are U.S. territories, protectorates and military installations.

Specialty Drug are drugs used as part  of the treatment  for many chronic  illnesses  and  complex diseases that commonly have special handling requirements. Navitus SpecialtyRx works with Diplomat Specialty Pharmacy to offer services with the highest standard of care. You will get one-on-one service with skilled pharmacists. They will answer questions about side effects. They will give advice to help you stay on course with your treatment. Specialty drugs are delivered free. They come right to your door or prescriber's office via FedEx.

Local courier service may be available for emergency, same-day medication needs. To start using Navitus SpecialtyRx, please call toll-free 877-651-4943. We will work with your prescriber for current or new specialty prescriptions.

A generic drug is a drug that is the same as a brand name drug in dosage, safety and strength. It is also the same in how it is taken, how it works in the body, quality, performance and intended use. Typically, generic drugs are less expensive than their brand counterparts. They can save you money by reducing copays or-in the case of over-the-counter drugs-by allowing less out-of-pocket expense at the cash register.

Plan Co-Pays

$5.00 Generic Drugs

You will pay the lowest copayment for generic drugs. Generics are equivalent to their brand-name counterparts, and are ensured by the Food and Drug Administration to be as safe and effective.  However, generics cost 30 to 70 percent less than brand-name drugs.  Navitus has automatic generic substitution for common drugs that have established generic equivalents.

$15.00 Preferred Brand-Name Drugs

These drugs are brand when a generic is not available.  These brand medications have been on the market for a long time and are widely accepted as a preferred brand but cost less than a non-preferred brand.  The cost for this level of brand drug is less than non-preferred drugs so the co-payment to the member is in line with the plan and gives the patient a lower cost for out of pocket.

$30.00 Non-Preferred Brand-Name Drugs

These drugs are new to the market and generally have a higher-cost in the market place.  In most cases a brand alternative preferred medication is available.  When this happens the new marketed drug is considered non-preferred.  This level of drug is not typically used as the first line of treatment so this level of drug often will have a step therapy and prior authorization needed because a preferred brand is available.

Navitus participates in step therapy program. What is step therapy? The step therapy program encourages safe and cost-effective medication use. Under this program, a "step" approach is required to receive coverage for certain high-cost medications. This means that to receive coverage you may need to first try a proven, cost-effective medication before using a more costly treatment, if needed. Remember, treatment decisions are always between you and your doctor.

A member filling a prescription for a drug flagged for step therapy will be given one of the alternative prescription drugs according to the step therapy guidelines.  A member who does not want the alternative drug because they've already tried it or because their doctor wants them on the specific medication prescribed will need to call Navitus to request a coverage review.  Navitus will then call the prescribing physician to get the necessary information that will allow the prescription to be filled as written.

Members can call Navitus now to determine if their current prescriptions are subject to step therapy requirements. 

1. Call Navitus at 1-866-333-2757
2. Introduce yourself as a new member
3. Use the code "SISC"
4. State the effective date:  July 1, 2015
5. State the prescription plan as:  5/15/30

With the above information the customer service representative can find the plan information and answer your questions.

For more information, please visit the Navitus website at www.navitus.com