Health Plans
We are committed to helping health plan clients achieve their goals of controlling cost, improving health, and growing their business.
We believe the status quo of the PBM industry—where the financial interests of traditional PBMs stand in the way of plan goals for lowest cost and trend control—can no longer stand as the benchmark.
Pass-through Model
Financial and Operational Transparency
Commitment to More Affordable Medications
Navitus Solutions
Innovative Solutions for Better Health Outcomes
Services & Solutions
We partner with health plan clients to define and implement multi-year strategies to:
Deliver clinically appropriate, lowest-net-cost therapies toward well-controlled PMPM trend
Enable high-quality standards of care, consistent with URAC and NCQA accreditations
Support effective member interventions to drive adherence and improved health
Provide advanced technology to meet all regulatory requirements
Support data integration and health information exchanges for coordination across provider networks
Dedicated Support
Team Expertise
Our Government Programs associates average 5+ years of experience each, and offer dedicated support for:
Benefit configuration and testing
Formulary development
Clinical and administrative prior authorization
Partnership-Focused Approach
Pharmacy and member support
Financial information reporting (FIR)
Compliance monitoring and audits
Flexible Plan Design and Implementation
Our clients have ultimate decision-making authority regarding their plan design and programs based on their preferences and benefit philosophy. This includes supporting decisions that drive optimal utilization of an in-house pharmacy for health systems.
Quality Outcomes
Our extensive experience working with health plans offers unique understanding of the requirements for consistently driving toward positive, measurable outcomes.
Our extensive service offerings integrate to support these goals and include:
- Data exchanges for the purposes of disease, case and utilization management and quality assurance (QA) support
- Timely concurrent and retrospective drug utilization review to identify potential member safety issues.
- Disease-state management prescriber interventions to improve prescribing quality and reduced medication errors
- Pharmacoadherence support to identify nonadherence within common disease states based on industry-standard metrics (medication possession ratio (MPR), proportion of days covered (PDC), or gap in therapy (GIT)).
Interested in learning more about Navitus?
Latest Insights
Health Plans 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…
