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 transparency that empowers them to make well-informed decisions for their plans and their members.
Our clients have clarity of contract, terms, data down to the claims level, our financials, and are even invited to participate in our formulary management process.
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:
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
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
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
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…
QUALYiQ 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 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
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
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…
Pharmacy and Practitioner Exclusions and How to Resolve Them
Prescribers and Pharmacies can be deemed ineligible for providing services to government programs like Medicare, Medicaid or even to payers who are participating in government programs. Being ineligible to provide those services is commonly referred to…
