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Navitus' Medicare EGWP Program Earns 5 Star CMS Rating, the Highest Rated PBM-Sponsored Plan

  • Nov 2, 2021
  • PBM Model

MADISON, Wis., November 2, 2021 – Navitus Health Solutions announced today that it earned a 5 out of 5 Overall Star Rating from the Centers for Medicare and Medicaid Services (CMS) for its MedicareRx Employer Group Waiver Plan (EGWP) for the 2022 plan year, giving it the highest score among pharmacy benefit management (PBM) sponsored EGWP plans in the nation. Navitus’ rating improved from a 4.5 the past three years to a 5 Star Rating, which is the company’s sixth year to rank higher than any other PBM. According to CMS, an overall 5 Star Rating assures EGWP clients and their members that the program provides high-quality clinical care and customer service.

Navitus’ EGWP program, Navitus MedicareRx, is managed by Navitus and is offered 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 medication therapy management and pharmacoadherence programs to promote positive behavior change. Advanced reporting provides additional member and provider-level insight to maximize interventions and improve clinical outcomes.

In addition to clinical care, the Overall 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.

“It’s beyond rewarding to see Navitus earn a 5 out of 5 Star Rating for the 2022 plan year and continue to maintain our position as the highest-rated PBM-sponsored plan in the country,” said David Fields, President and CEO, Navitus. “Our Health Strategies & Government Programs teams work hard every day to ensure our robust member-centric clinical care model continues to deliver high-touch support to promote medication adherence and improve health outcomes for plan sponsors and their members.”

Every year, Medicare evaluates plans based on a 5-star rating system. For more information on Star Ratings visit

About Navitus
Navitus Health Solutions, owned by SSM Health and Costco Wholesale Corporation, 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 hundreds of plan sponsors (i.e., employers, health plans, unions, governments, etc.) and their 7+ million members. By combining a unique pass-through approach that returns 100% of rebates and discounts 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 Follow Navitus on Twitter and LinkedIn to stay up-to-date on all the latest pharmacy benefit news, information and expert analysis.

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