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HomeMy WebLinkAboutNavitus - EPO Prescription Summary.pdfSmall Group Program My Benefits EPO Plan Home Delivery (90 days) Retail (In-Network) 30 days Generics $15 $10 Preferred Brands $50 $20 Non-Preferred Brands $112.50 $45 Specialty 30% up to $150 30% up to $150 Deductible (Individual/Family) $200 / individual; applies to brand name drugs only Out of Pocket Max (Individual/ Family) $5,300 / $10,600 Retail Refill Allowance The first three times that you purchase a long-term drug at a participating retail pharmacy, you’ll pay your retail co-payment. After the third purchase, you’ll pay a higher cost if you continue to purchase at retail. To avoid paying more, use the Costco pharmacy and pay your mail-order co-payment for up to a 90-day supply. That means you’ll pay less over time. Your medications will be delivered right to you, and standard shipping is free. Once you get started, you can request refills easily by mail, online, or over the phone. All plans are subject to IRS-mandated changes, including minimum deductible and out-of-pocket maximum requirements © 2025 Navitus Health Solutions, LLC. All rights reserved. 052532-0225 © 2025 Navitus Health Solutions, LLC. All rights reserved. 052532-0225 We Put People First Our goal as your pharmacy benefit manager (PBM) is to help minimize your out-of-pocket costs, so you have access to the prescriptions you need. We partnered with your employer to ensure you have: ■Knowledgeable and friendly customer support that’s dedicated to answering your questions the first time you call. ■Affordable and convenient access to the medications you need. ■Easy to understand information about your plan and how to manage your prescriptions effectively. ■Convenient online and mobile resources to quickly and easily locate the closest network pharmacy and to compare drug costs, anytime and anywhere. Quick Answers to Common Benefits Questions Which medications are covered? Check the formulary which can be viewed on the Navitus member portal on or after your benefit effective date. What is a formulary? A formulary is a list of prescription drugs covered by your plan. It includes both brand-name and generic medications and is organized by tiers that affect your copay. What are drug tiers and how do they affect my cost? Drugs are grouped into tiers (e.g., Tier 1 = generics, Tier 2 = preferred brands). Lower tiers usually mean lower out-of-pocket costs. What should I do if my medication isn’t covered? Talk to your doctor about alternatives or ask your PBM about the prior authorization or appeal process. A Quick Guide to Your Navitus Pharmacy Benefits Navitus Customer Care Provide your Carrier ID for the highest level of service. Available 24 hours a day, 7 days a week; Closed Thanksgiving & Christmas Carrier ID: https://benefitplans.navitus.com/nvpsm Costco Mail Order Lumicera Health Services 800-607-6861 855-847-3553 pharmacy.costco.com lumicera.com Monday - Friday, 7 a.m. - 9 p.m. CST Saturday, 11:30 a.m. - 4 p.m. CST Monday - Thursday, 8 a.m. - 7 p.m. CST Friday, 8 a.m. - 6 p.m. CST* *Closed weekends and major holidays Simplifying Prior Authorization, Step Therapy and Exception to Coverage There are certain conditions and medications which require extra steps to gain approval to fill the prescription, but we try to make it as easy as possible. ■Prior Authorization (PA) – Some prescriptions require prior authorization to be filled, which your health care provider will need to help facilitate. ■Step Therapy – When there’s an effective alternative available that’s less expensive for you, you may be asked to try that before a more expensive prescription is authorized. ■Exception to Coverage (ETC) – If a drug isn’t approved, you and your doctor can submit an ETC request showing alternative medications aren’t effective or suitable for your personal situation. ■Coverage Details - If there are any limits or requirements on your medications like the ones listed above, a Coverage Details button will appear on the medicine’s description page in the portal. Clicking on that button will outline what’s needed to get the prescription filled. Filling Your Prescriptions - You’ve Got Options ■Network Pharmacy – Most independent and all major chain pharmacies, are part of your benefit network. ■Costco Mail Order – A 90-day supply of maintenance medications can be mailed right to your door. You don’t need to be a Costco member to use their pharmacies. Just register online at pharmacy.costco.com to get started. ■Specialty Pharmacy - Lumicera Health Services, our specialty pharmacy partner, provides a high level of personalized care for members with complex conditions. Their clinical team will help you manage side effects and reduce complications, so you can focus on the things that matter most.