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Navitus Health Solutions' Medicare EGWP Program Earns a 4.5 Star CMS Rating

  • Dec 18, 2019
  • PBM Model
MADISON, Wis., December 18, 2019 – Navitus announced today that it recently received a 4.5 out of 5 Overall Star Rating for the second year in a row from the Centers for Medicare and Medicaid Services (CMS) for its Medicare Employer Group Waiver Plan (EGWP) for the 2020 plan year. An Overall 4.5 Star Rating assures EGWP clients and their members that the program is providing high quality clinical care and customer service, according to CMS. Navitus’ EGWP program, Navitus MedicareRx, is managed by Navitus and is underwritten by Dean Health Insurance.

Foundational to Navitus’ program is its focus on the clinical outcomes measures that fall under CMS’ Star Ratings. Using insightful analytics, clinicians identify members who are struggling with adherence and can benefit from additional support. Once identified, members receive educational communications through programs such as medication therapy management and pharmacoadherence to promote positive behavior change. Advanced reporting provides additional member and provider-level detail to maximize interventions and improve clinical outcomes.

In addition to clinical care, the Overall 4.5 Star Rating highlights Navitus’ superior customer service, as measured by the CMS-required CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey.  When Medicare members call Navitus Customer Care, they can expect to speak with someone who is knowledgeable about their pharmacy plan and who will provide options for resolving their individual needs.

“I’m very proud to have received the Overall 4.5 Star Rating for two years in a row, which is the highest among pharmacy benefit management (PBM) sponsored EGWP plans in the industry,” said David Fields, President and CEO. “This demonstrates that CMS and our own Medicare members recognize our commitment to superior service. At Navitus, we will continue to make sure that each employee is dedicated to improving health and providing superior customer service with every Medicare member interaction.”

About Navitus
Navitus Health Solutions, a division of SSM Health, serves as a full pass-through pharmacy benefit manager (PBM) and industry alternative to traditional models. As such, Navitus is committed to taking the unnecessary costs out of pharmacy benefits to make prescriptions more affordable for plan sponsors (i.e. employers, health plans, unions, governments, etc.) and their members. By combining a unique pass-through approach that returns 100% of rebates with a focus on lowest-net-cost medications and comprehensive clinical care programs, Navitus helps reduce costs and improve member health. To learn more about Navitus, call 877.571.7500 or visit

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