Navitus Health Solutions is the administrator of the UC PPO plans prescription drug benefit. How the Plan Works What's Covered and What You Pay Formulary Changes Filling Prescriptions Money-Saving Options Restrictions and Rules How the Plan WorksPrescription drugs are managed by Navitus Health Solutions (Navitus). Sign in to the Navitus member portal to access a variety of tools that include viewing what’s covered by the Navitus formulary, previewing drug costs, and finding pharmacies near you. What’s Covered and What You PayWhat’s CoveredThe formulary, or preferred drug list, is a list of drugs that are covered under the plan. Medications on the list are grouped into four tiers.
For questions about what’s covered and your costs, call Navitus Customer Care at (855) 673-6504, available 24 hours a day, 7 days a week, except Thanksgiving and Christmas Day. About the FormularyWhat to Know About the Formulary A formulary is an extensive list of safe, effective medications covered by a health plan. Every pharmacy benefit manager (Navitus, for the UC PPO plans) uses its own formulary and it changes over time as new drugs enter the market and brand-name patents expire, etc. Generally, if drugs aren’t on the formulary, they aren’t covered by the plan. The Navitus formulary is divided into 4-tiers. The lowest cost drugs (mostly generic) are in Tier 1. The highest cost medications are in Tier 4 (specialty). What does this look like?Say you are newly diagnosed with high blood pressure and your doctor prescribes Atenolol to treat it. A quick scan of the formulary shows Atenolol is a generic equivalent for the brand-name drug Tenoretic. It also classifies Atenolol as a Tier 1 medication, so you know what you’ll pay.  The formulary also will show if any restrictions and rules apply, such as prior authorization, quantity limits or step therapy. When filling a PrescriptionFind out if the drug is covered first. A quick search of the Navitus formulary will tell you. Download the Navitusplus app to have the formulary with you at the doctor’s office. If the drug the doctor recommends isn’t listed, you can look for alternatives in real time. If you don’t see the drug on the formulary, you or your doctor can contact Navitus Customer Care at (855) 673-6504 for help. If there’s a generic version of a drug you are prescribed and you choose the brand-name drug instead, you’ll pay a penalty. Formulary Updates Occasionally, the formulary is updated. Updates are shown below. See the 2022 Formulary for more details about your Medicare and Navitus prescription drug coverage. October
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What You Pay
Filling PrescriptionsRetail PharmaciesYou can fill up to a 90-day supply through the Navitus national network of retail pharmacies, which includes Costco, CVS, Walgreens, Walmart, Safeway/Vons and more. Sign in to the Navitus member portal to view the full list of network pharmacies and find one near you. UCMC PharmaciesPrescription drug fills and refills are available at many UC Medical Center pharmacies [PDF]. Mail-OrderGet up to a 90-day supply of medication without leaving home. Use the Costco Mail Order Pharmacy for maintenance medications, such as those taken on an ongoing basis to treat chronic conditions like asthma, diabetes, high blood pressure and high cholesterol. Home delivery makes it quick and convenient. Start a new prescription and request refills online or use the mail order form [PDF], and your prescription will be delivered to you by mail. Learn more about how to order through mail order [PDF]. Specialty MedicationsFor prescription drugs used to treat complex conditions, Navitus offers members access to a specialty pharmacy, Lumicera Health Services. Ordering new prescriptions through Lumicera Health Services is simple, and you can get free delivery of specialty medications to your home or other locations. Just visit Lumicera online or call (855) 847-3553 to get started, or work with your provider to use select UC pharmacies. Note: Specialty prescription medications administered in your doctor’s office (e.g., Botox) may be covered under your prescription drug benefit. Money-Saving OptionsTablet SplittingTablet splitting is breaking a higher-strength drug tablet in half to deliver the same prescribed dose as a full tablet. This means you get the exact same drug and dosage, but you save money by paying for fewer tablets. For medications that can easily be cut in half without compromising efficacy, you can save up to 50% on out-of-pocket costs for select medications by having your doctor write a prescription for double the strength (e.g., 20 mg instead of 10 mg) and simply splitting the tablets in half. Specialty Split FillSpecialty medications are often expensive and can include side effects, which can cause people to stop taking the drug or modify their dosage. This program gives you time to discover whether a certain class of drugs will work for you, without wasting money on unused medications or risking complications caused by discontinued use. Here’s how it works: When you receive a 30-day prescription, you’ll receive one 15-day supply at a prorated cost. This gives you two weeks to see how well you tolerate the drug or to talk to your doctor about switching to a different medication. Restrictions and RulesBrand Name Drug Penalty May ApplyWhen a generic drug is available and you or your physician choose the brand-name drug, you must pay the applicable brand copay plus the difference between the cost of the brand-name drug and the generic equivalent. If a prior authorization is approved for a medical necessity exception, you will pay the Tier 3 (non-preferred) cost. Prior AuthorizationSome drugs, and certain amounts of some drugs, require an approval by Navitus before they can be filled. Generally, your doctor must show that a particular drug is medically necessary. Learn more about prior authorization. Quantity LimitsTaking too much medication or using it too often isn’t safe and may even increase your costs. If you refill a prescription too soon or your doctor prescribes an amount higher than recommended guidelines, the Navitus pharmacy system will reject your claim. If your doctor believes your situation requires an exception, the doctor can contact Navitus to request prior authorization review. Step TherapyIf your doctor prescribes a more expensive drug when a lower-cost alternative is available, you may be required to first try the less expensive drug that’s been proven to be effective — before you can “step” up to the more expensive medication. Drugs that require step therapy include those used to treat ADHD, diabetes, high cholesterol and multiple sclerosis. What type of insurance is navitus?Whole Life Insurance with Long-Term Care – Navitus offers this as an optional plan; it is a permanent insurance protection that provides living benefits for long-term care needs in addition to the long-term disability policy's income protection.
Is Navitus Health Solutions Medicare?Navitus MedicareRx (PDP) is a prescription drug plan that includes both Medicare Part D coverage and an employer-sponsored "wrap" plan.
Who is navitus owned by?Navitus Health Solutions, owned by SSM Health and Costco Wholesale Corporation, is a disruptive industry alternative to traditional pharmacy benefit manager (PBM) models.
Who is navitus specialty pharmacy?MADISON, Wis., February 11, 2021 – Navitus Health Solutions, a full pass-through pharmacy benefit manager (PBM), today announced that Lumicera Health Services, its wholly-owned specialty pharmacy, has purchased a specialty pharmacy from CareMetx, a leading technology-enabled hub services company committed to improving ...
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Navitus health solutions prior authorization form pdf
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