Navitus Medicare EGWP Program Receives 5-Star CMS Rating

October 17, 2017

MADISON, Wis., October 17, 2017 – Navitus Health Solutions has received a 5 out of 5 Overall Star Rating for the second year in a row from the Centers for Medicare & Medicaid Services (CMS) for its Medicare Employer Group Waiver Plan (EGWP) for the 2018 plan year. An Overall 5-Star Rating assures EGWP clients and their members that the program is providing the highest quality clinical care and customer service, according to CMS. Navitus’ EGWP program, known as Navitus MedicareRx, is managed by Navitus and underwritten by Dean Health Insurance.

Navitus has a program specifically designed to focus on the clinical outcomes measures of CMS’ Star Ratings. Medicare Clinical Programs staff at Navitus continue to make significant enhancements in the company’s analytical capability to identify, track and trend Medicare members who may not be adherent to their medications. Programs in place, such as Medication Therapy Management and Pharmacoadherence, track members who may be non-adherent and trigger communications to change member behaviors. Plus, our advanced reporting provides additional member and provider-level detail to maximize outreach efforts and clinical outcomes.

In addition to clinical safety services, the Overall 5-Star Rating spotlights Navitus’ superior customer service, as measured by the CMS-required CAHPS (Consumer Assessment of Healthcare Providers & Systems) survey. When Medicare members call Navitus Customer Care, they can expect to speak with someone who is knowledgeable about their pharmacy plans and who will provide options for resolving their individual needs.

“At Navitus, each employee is dedicated to improving health and providing superior customer service with every Medicare member interaction,” said Terry Seligman, President and CEO of Navitus. “We are very proud to have received the Overall 5-Star Rating for two years in a row. This demonstrates that CMS and our own Medicare members have recognized our commitment to superior service for our Medicare members.”

Star Ratings are assessed each year and may change from one year to the next.

About Navitus

Navitus Health Solutions, LLC, a division of SSM Health, is a full-service, URAC-accredited pharmacy benefit management company. As a zero-spread, full pass through pharmacy benefit manager (PBM), Navitus aligns performance with plan sponsors’ benefit goals to deliver comprehensive clinical programs and cost-saving strategies that lower drug trend and promote good member health. Navitus provides its flexible services to government entities, self-funded employers, coalitions, labor organizations, third-party administrators, and health plans, including managed Medicaid, Exchanges, and Medicare Part D. For more information about Navitus’ tangible solutions to the rising cost of health care, visit www.navitus.com or call 877-571-7500.

Stay Informed and Connected

Receive expert insights, healthcare tips, and important updates on pharmacy benefits, drug recalls, and more—straight to your inbox.

Examining Trends that Drive Informed Decisions

Now Available: 8th Annual Drug Trend Report

See the latest results and access industry insights you need to navigate current trend drivers.

Related blogs

Navigating Healthcare and Improving Outcomes

Navitus to Remove Stelara® from Formulary July 1, 2025, Adds Biosimilars to Drive $120 Million in Savings 

Navitus to Remove Stelara® from Formulary July 1, 2025, Adds Biosimilars to Drive $120 Million in Savings 

As the nation’s first 100% transparent, pass-through PBM, we continue to advance medication affordability by prioritizing upfront, real-time savings over rebated models….

Achieving Outstanding Results with Tailored Network Strategies

Achieving Outstanding Results with Tailored Network Strategies

A medium-sized city in Michigan with 1,350 members was seeking ways to lower its pharmacy benefit costs, which were growing under its existing traditional pharmacy benefit manager (PBM). With its member covered by a two-tier, open formulary including…

Breaking Through Barriers with Value-Based Plan Design

Breaking Through Barriers with Value-Based Plan Design

Facing increased pharmacy benefit expenses, Blain’s Farm and Fleet, a Midwestern employer group, desired to improve plan performance. Specifically it was interested in educating eligible members about the benefits available to them, promoting cost-effective…

Finding a Solution to Lower Prescription Drug Costs

Finding a Solution to Lower Prescription Drug Costs

The Rural Arizona Group Health Trust (RAGHT) wanted to gain better control of its escalating drug trend with its large, traditional pharmacy benefit manager (PBM). Having only worked with traditional PBMs in the past, RAGHT was interested in exploring…

Empowered by Strategic Opportunities and Service Excellence

Empowered by Strategic Opportunities and Service Excellence

Putnam | Northern Westchester Health Benefits Consortium (PNW HBC) was the first municipal cooperative health plan in the state of New York to become certified by the Department of Insurance. They are dedicated to meeting — and exceeding — the standards…

QALYiQ Program Delivers Significant Savings for Both Members and Health Plans

QALYiQ Program Delivers Significant Savings for Both Members and Health Plans

As part of their treatment plan for hypophosphatasia (HPP), a rare genetic disorder affecting bone and teeth development, one of our members required Strensiq, a medication designed to manage HPP. However, Strensiq’s annual treatment costs ranged from…

RISE: Reporting and Intervention for Stars Excellence

RISE: Reporting and Intervention for Stars Excellence

RISE is a comprehensive Star Ratings Improvement program that focuses on positive outcomes for Medicare Part D (Part D) clinical measures, including: medication adherence for diabetes medications, medication adherence for hypertension, medication adherence…

Medication Therapy Management: Improving Health Outcomes and Reducing Cost

Medication Therapy Management: Improving Health Outcomes and Reducing Cost

Patients with chronic diseases can face greater risks for medication-related challenges such as non-adherence. This can lead to poor health outcomes and higher plan costs. That’s why we developed an MTM program, offered through our Clinical Engagement…

Personalized Member Transitions: Creating a Smoother Benefit Transition

Personalized Member Transitions: Creating a Smoother Benefit Transition

Navigating benefit transitions is no easy task. Our personalized member transition (PMT) program makes it smoother for both plan sponsors and members. Through our high-touch outreach to members, we eliminate gaps in care, minimize member disruption, improve…

previous arrow
next arrow