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 their 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 that 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 which continues today.
Navitus MedicareRx (PDP) has received a
4.5 out of 5 Part D Star Rating for the 2026 plan year.
This marks OUR tenth consecutive year as the highest rated PBM-sponsored PDP EGWP plan, 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…
