Health Plans
Working together, we optimize pharmacy costs and clinical care, so that our clients can focus on caring for, retaining and expanding membership.
We are committed to helping health plans achieve goals of controlling cost, improving health and growing their business.
Pass-through Model
Financial and Operational Transparency
Commitment to More Affordable Medications
Aligned Support & Quality Outcomes
Built to Advance Client Goals
The Navitus PBM was established more than 20 years ago by two regional health plans. They were unsatisfied with spread-based PBM models that stood in the way of lower drug costs. The founding Navitus model focused on controlling total cost of care through aligned partnership to effectively manage drug trend. This continues today.
The Navitus MedicareRx EGWP PDP has received a 4.5 our of 5 Part D Star Ratings for the 2025 plan year. This marks the ninth consecutive year as our highest rated PBM-sponsored EGWP plan and is the result of ongoing focus to deliver exceptional clinical quality, stellar member services and operational excellence.
products & Services
As a full-service PBM partner, we work with health plans to define and implement multi-year strategies that:
Control pharmacy cost and per member per month (PMPM) trend
Advise on formulary design in partnership with health plan Pharmacy & Therapeutics Committees
Support therapy adherence and disease state management by assisting prescriber and member interventions
Facilitate quality outcomes and care consistent with URAC and NCQA accreditations
Coordinate across provider networks through data integrations and health information exchanges
Further membership growth strategies
Dedicated Expertise
Government Programs
We have extensive experience supporting clients with Medicare and Medicaid lines of business. Since 2006, we have administered the Medicare Part D benefit and navigated compliance and government program requirements. Nearly 20 years later, we continue to provide Medicare Part D support for 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)
- Prescription Drug Plan (PDP) EGWP
Learn more about our programs designed specifically for these lines of business.
Interested in learning more about Navitus?
Latest Insights
Health Plan Insights: Navigating Healthcare and Improving Outcomes
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…
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…
Against the Grain: An Innovative Approach to Pharmacy Benefit Management
Partnering with a PBM that is aligned with your company goals is essential to achieving quality care at affordable costs, but knowing what to look for when selecting a PBM partner can be challenging. During a recent The Conference Board webinar, Gary…
The Keys to Lowering Your Rx Benefit Costs
Hear first-hand how Texas Association of Counties (TAC) fine-tuned its Rx benefit plan performance and experienced significant savings. Watch the on-demand webinar to find out how. During a recent State and Local Government Benefits Association (SALGBA)…
Why Aligning With the Right PBM Ensures Timely Access to Medications
Mail delays have little impact upon Navitus members. Find out why. Since March, we have seen an uptick in the number of members participating in retail extended or mail order prescriptions. At the same time, there have been anecdotal accounts of delays…
Creating a More Successful PBM-Client Relationship
Finding the Right PBM Partner Finding a prescription benefit manager (PBM) that offers savings, flexibility and alignment to the plan sponsor’s goals can be a challenge. With the availability of varying models, ranging from traditional to pass-through,…
Taking the Unnecessary Costs Out of Pharmacy Benefits
Identifying Opportunities for Savings Concerned about growing prescription expenses, the State of Montana (the State) knew it was time for a change. With its traditional pharmacy benefit manager (PBM), costs reached levels equating to almost 20% of its…
