Skip to Content

Navitus Receives NCQA Utilization Management Accreditation

  • Oct 5, 2021
  • PBM Model
MADISON, Wis., October 5, 2021 – Navitus Health Solutions, a full pass-through pharmacy benefit manager (PBM), announced today its accreditation by the National Committee for Quality Assurance (NCQA) in Utilization Management (UM). NCQA Utilization Management Accreditation focuses on consumer protection and improvement in service to customers. Standards recognize that organizations that apply for accreditation have open access networks and can improve service quality and utilize customized structures to meet purchaser needs.

“Transparency and accountability are at the core of Navitus’ values,” said David Fields, president and CEO of Navitus Health Solutions. “Receiving NCQA’s UM accreditation is a testament to the high-quality clinical service Navitus provides to plan sponsors and their members. We are thrilled to be recognized by this industry-standard, evidence-based program that showcases Navitus’ commitment to lowering drug costs, improving health, and providing superior customer service.”

Navitus’ Utilization Management program is designed to keep members healthy and avoid wasteful drug spending. Through its transparent, 100% pass-through model, Navitus ensures that members receive appropriate, cost-effective therapy through utilization management programs such as prior authorization, step therapy and split fill. By aligning with plan sponsors on their incentives, Navitus promotes appropriate utilization and can reduce plan sponsor costs without impacting clinical effectiveness for members.

“Achieving NCQA Utilization Management Accreditation demonstrates that Navitus has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards,” said Margaret E. O’Kane, President, NCQA.

NCQA has reviewed and accredited Navitus’ Utilization Management functions only. For complete details on the scope of this review, 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.

About NCQA
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website ( contains information to help consumers, employers and others make more informed health care choices. NCQA can be found online at, on Twitter @ncqa, on Facebook at and on LinkedIn at

For media inquiries, contact

Associated People