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Frequently Asked Questions

We are devoted to our members and their satisfaction and health is our top priority. High-touch, personalized service and our member web portal are two of the ways we help our members save time and money and stay healthy. We understand how important it is for you to get the prescriptions you need when you need them. We are here to help you.

Following is a list of frequently asked questions from members. For even more information specific to your plan, please log into the Member Portal.

What is Navitus Health Solutions?

Navitus Health Solutions is a pharmacy benefit manager. We provide cost-effective prescription drug benefits for our clients and their members. Our mission is to improve member health and minimize their out-of-pocket costs.

What is a pharmacy benefit manager?

A pharmacy benefit manager (PBM) processes and pays prescription drug claims for its members. It contracts with pharmacies and builds and maintains drug formularies. A PBM also negotiates discounts and rebates with drug manufacturers.

I’m new to Navitus; do I need to change to a new pharmacy?

Most often, you will be able to continue to use your current pharmacy. There are more than 64,000 pharmacies in the Navitus network. Please provide your ID card information to the pharmacy when you fill a prescription. This will ensure you pay only the member out-of-pocket expense for your prescription.

Where can I search for Navitus network pharmacies?

A complete list of pharmacies is available in the Navi-Gate for Members portal. If the pharmacy you currently use is not listed, please contact Navitus Customer Care toll-free at the number listed on your pharmacy benefit member ID card to confirm whether your current pharmacy is participating with Navitus.

How do I determine if a particular drug is covered? How do I determine what my copayment will be for this drug?

Your formulary (preferred drug list) is available in Navi-Gate for Members. The coverage associated with each drug is noted on the formulary. Also included is information regarding which drug products are subject to prior authorization and/or quantity limits and drugs that are part of the RxCents Tablet Splitting Program. The formulary does not specifically indicate the dollar amount members can expect to pay for each drug product. The formulary document does not list every covered medication. See your Schedule of Benefits for more information.

How do I fill a prescription when I travel for business or vacation?

If you are traveling and require the dispensing of covered drugs, the following policy applies:

If traveling for less than one month:

  • Any participating pharmacy can arrange for an additional one-month supply to be taken with you. A copayment or coinsurance will apply to each month's supply;
    or
  • You can request that your participating pharmacy mail a one-month supply to you at the address where you will be staying.

If traveling for more than one month, but within the United States:

  • You can request the participating pharmacy located in the area where you will be traveling to request your current pharmacy to transfer your prescription order.
  • You can request that your physician write an additional prescription order to be taken with you during your trip, with the intention that this prescription will be dispensed at a participating pharmacy located in the area where you will be traveling.

If traveling for more than one month outside the United States:

  • Please contact Customer Care toll-free at the number listed on your pharmacy benefit member ID card for information regarding the dispensing of covered drugs while out of the country.
How do I request reimbursement for pharmacy claims?

A member can make a request for reimbursement by completing the Direct Member Reimbursement form (PDF). You will be reimbursed directly for covered services up to the Navitus contracted amount. All requests for member reimbursement should be directed to the following address:

Navitus Health Solutions, LLC
Operations Division - Claims
P.O. Box 999
Appleton, WI 54912-0999

Who do I contact if I have general questions about my pharmacy benefit (e.g. eligibility in system, claims questions, request for replacement ID card, etc.)?

Please contact Customer Care toll-free at the number listed on your pharmacy benefit member ID card for questions about your pharmacy benefit.

When is Navitus Customer Care available?

24 hours a day, 7 days a week (closed Thanksgiving and Christmas Day)

Useful Contacts

Prior Authorization Team

Phone - Main Line
(866) 333-2757
FAX - Commercial
(855) 668-8551
FAX - Medicare
(855) 668-8552
FAX - Medicaid
(855) 668-8553
Mailing Address
Navitus Health Solutions LLC
Attn: Prior Authorizations
1025 West Navitus Drive
Suite 600Appleton, WI54913