Skip to Content

Navitus Medicare EGWP Program Receives 5-Star CMS Rating

  • Oct 17, 2017
  • PBM Model

MADISON, Wis., October 17, 2017 – Navitus Health Solutions has received a 5 out of 5 Overall Star Rating for the second year in a row from the Centers for Medicare & Medicaid Services (CMS) for its Medicare Employer Group Waiver Plan (EGWP) for the 2018 plan year. An Overall 5-Star Rating assures EGWP clients and their members that the program is providing the highest quality clinical care and customer service, according to CMS. Navitus’ EGWP program, known as Navitus MedicareRx, is managed by Navitus and underwritten by Dean Health Insurance.

Navitus has a program specifically designed to focus on the clinical outcomes measures of CMS’ Star Ratings. Medicare Clinical Programs staff at Navitus continue to make significant enhancements in the company’s analytical capability to identify, track and trend Medicare members who may not be adherent to their medications. Programs in place, such as Medication Therapy Management and Pharmacoadherence, track members who may be non-adherent and trigger communications to change member behaviors. Plus, our advanced reporting provides additional member and provider-level detail to maximize outreach efforts and clinical outcomes.

In addition to clinical safety services, the Overall 5-Star Rating spotlights Navitus’ superior customer service, as measured by the CMS-required CAHPS (Consumer Assessment of Healthcare Providers & Systems) survey. When Medicare members call Navitus Customer Care, they can expect to speak with someone who is knowledgeable about their pharmacy plans and who will provide options for resolving their individual needs.

“At Navitus, each employee is dedicated to improving health and providing superior customer service with every Medicare member interaction,” said Terry Seligman, President and CEO of Navitus. “We are very proud to have received the Overall 5-Star Rating for two years in a row. This demonstrates that CMS and our own Medicare members have recognized our commitment to superior service for our Medicare members.”

Star Ratings are assessed each year and may change from one year to the next.



About Navitus
Navitus Health Solutions, LLC, a division of SSM Health, is a full-service, URAC-accredited pharmacy benefit management company. As a zero-spread, full pass through pharmacy benefit manager (PBM), Navitus aligns performance with plan sponsors’ benefit goals to deliver comprehensive clinical programs and cost-saving strategies that lower drug trend and promote good member health. Navitus provides its flexible services to government entities, self-funded employers, coalitions, labor organizations, third-party administrators, and health plans, including managed Medicaid, Exchanges, and Medicare Part D. For more information about Navitus’ tangible solutions to the rising cost of health care, visit or call 877-571-7500.