Solutions
Innovative Solutions for Better Health Outcomes
Navitus offers a suite of pharmacy benefit solutions to lower costs, improve patient care and simplify management. Our approach emphasizes transparency, collaboration and innovative strategies that deliver results for clients and members.
Our Core Solutions
Each of our pharmacy benefit solutions is crafted to meet the unique needs of our partners—ensuring accessible, affordable and effective care for all.
100% Pass-through Approach
No rebate chasing. No spread chasing.
Just a clear, easy to understand, set fee.
Which means as a pass-through model PBM, we’re able to make decisions that align with your organization’s goals, regardless of the potential impact to spread, margins or rebate dollars.
Because we don’t benefit when medication prices increase, our focus remains uninterrupted on lowering overall drug spend, supporting your organization’s unique financial and operational needs and ensuring that members can receive the care they need at a price they can afford.
100% Financial and Operational Transparency
Transparency is more than just a buzzword.
It’s our standard.
Without spread pricing to influence things, our clients experience a level of transparency that empowers them to make well-informed decisions for their plans and their members.
Our clients have clarity of contract, terms and data down to the claims level and our financials, and they are even invited to participate in our formulary management process.
Our pass-through model ensures clients receive 100% of the savings created through our lowest-net-cost formulary model, utilization management (UM) and negotiated rebates.
AWP – Average wholesale price
How Transparent is Your PBM?
Lowest-net-cost Formulary Management
Our formularies are crafted based on clinical data and are designed to manage cost without sacrificing quality of care.
We believe effective formularies:
Navitus offers four, standard formularies:
- Signature Select
- Signature Traditional
- Extended Preferred
- Extended
Traditional PBMs often make formulary decisions based on generating higher rebates—not lowest-net-cost—because they keep a portion of rebates for profit.
We pass all rebates back to our clients, so we’re able to stay focused on developing effective formularies that manage cost and keep quality of care high rather than making decisions that pad profits.
Cost-plus Specialty Pharmacy
Just 2% of patients have chronic illness, yet that’s where more than 50% of drug spend is. That means specialty drugs are one of the largest cost-drivers, and with new, specialty drugs entering the market each year, keeping costs in check is a must.
Framed by our guiding principles of transparency and quality care, our specialty pharmacy, Lumicera offers an innovative Acquisition Cost Plus solution—which means clients only pay the actual acquisition cost (AAC) plus shipping and a flat patient-management fee.
Why clients choose Lumicera:
- The cost-plus pricing model helps control specialty drug costs
- Their AWP discount increases when drug costs increase, creating downward pressure on price paid
- The First In, First Out (FIFO) accounting methodology ensures inventory cost is never inflated
We don’t require or push our clients to choose Lumicera as their specialty pharmacy solution, but we are proud of the work they do and their dedication to improving specialty pharmacy care, one patient at a time.
Cost-plus specialty pharmacy in the country
Largest specialty pharmacy, serving the U.S. and Puerto Rico
Member Net Promotor Score (NPS)
Excellence in Government Programs Support
Dedicated to delivering exceptional clinical quality, stellar member services and operational excellence, our government program support models include:
- Dedicated experts with an average of 5+ years of tenure
- Ongoing monitoring and adherence to industry, federal and state regulations
- Customer success teams to assist with annual bid submissions, member material reviews, interpretation and execution of Medicare Part D guidance and annual reimplementation activities
We provide Part D support for health plan clients in more than 20 states, including:
- Medicare Advantage (MAPD)
- MAPD Employer Group Waiver Plan (EGWP)
- Dual Eligible and other Special Need Plans (D-SNP, C-SNP, I-SNP)
- Medicare-Medicaid Plans (MMP)
- Program of All-Inclusive Care for the Elderly (PACE)
- Standalone Prescription Drug Plan (EGWP)
With dedicated programs for Stars rating improvement, Medication Therapy Management and Personalized Member Transition, our clients and their members get to experience the true value of integrated pharmacy and medical benefits.
Navitus celebrates its ninth consecutive year as the highest rated PBM-sponsored EGWP plan, scoring 4.5 out of 5 stars
Member Enablement and Support Services
Navigating benefit transitions can be daunting. We’re here to make sure your members feel supported instead of anxious by helping them understand their benefits and opportunities to optimize their benefit offerings you’ve designed.
We minimize member disruption with:
- Personalized member transition support
- High-touch onboarding
- Formulary transition support through personalized outreach by staff clinicians
- Robust member portal and app offerings to facilitate understanding and benefit utilization
- 24/7 call center support with translation services available
Real Stories. Real Impact.
At Navitus, we’re proud to partner with organizations and individuals who trust us to provide affordable, transparent pharmacy benefits.
Discover how Navitus can help transform your pharmacy benefits. Let’s start a conversation and create a plan that works for you.
Latest Insights
Our latest insights, testimonials and more:
An Automated Approach to Diagnosis Verification of GLP-1 RA for Type 2 Diabetes Mellitus (T2DM)
This study examines the impact of implementing an automated point-of-sale diagnosis verification system for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared to traditional utilization management approaches….
