What Is Navitus Health Solutions

Navigating the world of healthcare can often feel like deciphering a complex code, especially when it comes to prescription medications. With rising drug costs and intricate benefit plans, many people find themselves asking: "What exactly is a Pharmacy Benefit Manager (PBM), and more specifically, What Is Navitus Health Solutions?" If you've ever felt overwhelmed by your prescription costs or confused about how your medications are managed, you're not alone.

This comprehensive guide will demystify Navitus Health Solutions, explaining their unique approach to pharmacy benefits and how they aim to make medications more affordable and accessible for you.

Understanding Pharmacy Benefit Managers (PBMs) First

Before we dive into What Is Navitus Health Solutions, it's helpful to understand the role of a Pharmacy Benefit Manager (PBM). Think of a PBM as an intermediary in the complex drug supply chain. PBMs manage prescription drug benefits for health plans, employers, and government programs. Their primary functions typically include:

• Negotiating discounts and rebates with drug manufacturers.
• Creating and maintaining drug formularies (lists of covered medications).
• Processing prescription claims.
• Managing pharmacy networks.
• Offering mail-order pharmacy services.

While PBMs play a crucial role in managing drug costs, their business models can vary significantly, impacting how much savings are passed on to the consumer or plan sponsor.

So, What Exactly Is Navitus Health Solutions?

Navitus Health Solutions is a prominent Pharmacy Benefit Manager (PBM) that stands out in the healthcare landscape due to its distinct operating model. Founded in 2003, Navitus was established as an alternative to the traditional PBM model, aiming to bring greater transparency and affordability to prescription drug management.

Owned by SSM Health and Costco Wholesale Corporation, Navitus Health Solutions is purpose-driven, focusing on helping people by actively working to remove unnecessary costs from the drug supply chain. Their core mission is straightforward yet impactful: to make medications more affordable for the people who need them, enabling them to live fuller, healthier lives.

The Navitus Difference: A Transparent Pass-Through Model

What truly sets Navitus Health Solutions apart from many other PBMs is its commitment to a transparent, 100% pass-through PBM model. But what does this mean for you and your health plan?

In a traditional PBM model, the PBM might negotiate discounts and rebates from drug manufacturers but then keep a portion of those savings as profit – often referred to as "spread pricing." This lack of transparency can make it difficult for health plans and members to understand the true cost of their medications.

Navitus operates differently. They pass 100% of all negotiated rebates and discounts directly back to the plan sponsor. Their revenue primarily comes from a clear, upfront administration fee. This "full pass-through" approach means:

• No Hidden Fees: You and your plan sponsor get a clear view of drug costs, rebates, and fees.
• Maximized Savings: All savings achieved through negotiations are returned to the client, leading to potentially lower overall drug spending. In fact, Navitus states their transparent pricing model can reduce prescription drug costs by up to 20% compared to traditional PBMs.
• Auditable Costs: Plan sponsors have comprehensive audit rights, allowing them to verify savings down to the individual claim level.

This commitment to financial and operational transparency has been a cornerstone of Navitus's strategy for over 20 years, aiming to disrupt the industry and set a new standard for accountability.

How Navitus Works to Benefit You

Navitus Health Solutions provides a comprehensive suite of services designed to manage prescription benefits effectively and put members first. Serving over 11 million people through more than 1,000 client relationships, Navitus works with various entities, including employers, health plans, and government programs.

Here’s how they operate to support your medication needs:

• Strategic Negotiations: Navitus actively negotiates with drug manufacturers to secure the best possible prices for medications. They also engage with pharmacies to help reduce costs at the point of sale.
• Formulary Management: They work with your health plan to develop a formulary – a list of covered, cost-effective drug options. This list is carefully curated to ensure access to clinically appropriate medications while managing costs.
• Convenient Pharmacy Network: Navitus contracts with a vast network of pharmacies nationwide, including major national chains and regional groups, ensuring you can easily access your prescriptions.
• Mail Order and Specialty Pharmacy Services: For maintenance medications, Navitus offers convenient mail-order services, often allowing you to receive a 90-day supply delivered directly to your door. They also manage specialty medications through their wholly-owned subsidiary, Lumicera Health Services, which employs a transparent, cost-plus model for these complex and often high-cost drugs, providing personalized support from skilled pharmacists.
• Online Member Portal (Navi-Gate for Members): Navitus provides an online portal, Navi-Gate for Members, offering a wealth of information. Through this portal, you can find local pharmacies, review your medication profile, and identify potential cost-saving options.
• Dedicated Customer Care: Have questions about your pharmacy benefit? Navitus Customer Care is available to assist members, providing knowledgeable and timely responses.
• Innovative Partnerships: Navitus continuously seeks partnerships to enhance member value. For example, they've partnered with GoodRx to offer the "Savings Connect" program, which can provide automatic access to lower GoodRx prices on generic drugs at the pharmacy counter. They've also teamed up with Noom for Work to offer preventive health programs focused on metabolic and stress management for their clients and members. Furthermore, Navitus has collaborated with Costco Pharmacy to implement cost-plus pricing for select prescriptions, offering transparency on what Costco pays for a drug, plus a fixed markup and fee.

Key Advantages of Choosing Navitus Health Solutions

For both plan sponsors and individual members, the Navitus model offers several compelling advantages:

• Significant Cost Savings: By passing through 100% of rebates and focusing on low net-cost strategies, Navitus aims to reduce overall prescription drug spend.
• Unmatched Transparency: The fully pass-through model provides clear visibility into drug costs, allowing for better financial management and accountability.
• Enhanced Member Experience: With tools like the Navi-Gate portal, dedicated customer care, and programs like step therapy that encourage cost-effective medication use, members are empowered to manage their health and medication costs more effectively.
• Focus on Patient Health: Navitus emphasizes improving health outcomes by ensuring access to affordable medications and providing support for complex conditions, including specialty drugs.

Conclusion

Understanding What Is Navitus Health Solutions reveals a PBM that prioritizes transparency and affordability in a healthcare system often criticized for its complexity. By operating with a 100% pass-through model, Navitus aims to simplify prescription benefits, drive down costs, and ultimately make essential medications more accessible to millions of people. Their commitment to clarity, combined with strategic partnerships and member-focused services, positions them as a distinct player in the pharmacy benefits industry.

Are you curious about how a transparent PBM model could impact your prescription costs or your organization's health plan? Explore the resources available through Navitus Health Solutions and discover a different approach to managing your medication benefits.

Frequently Asked Questions

What is a Pharmacy Benefit Manager (PBM)?

A Pharmacy Benefit Manager (PBM) is a company that manages prescription drug benefits for health insurance companies, large employers, and other plan sponsors. They handle tasks like negotiating drug prices, processing claims, and creating drug lists (formularies).

How is Navitus Health Solutions different from other PBMs?

Navitus Health Solutions distinguishes itself through its 100% transparent, pass-through model. Unlike many traditional PBMs that may retain a portion of negotiated rebates or use "spread pricing," Navitus passes all discounts and rebates directly back to the plan sponsor. Their revenue comes solely from an administration fee, ensuring full financial visibility.

How can I access my Navitus benefits information?

If you are a Navitus member, you can typically access your benefits information through the "Navi-Gate for Members" online portal on the Navitus website (navitus.com). This portal allows you to find pharmacies, review your medication profile, and identify cost-saving options. You can also contact Navitus Customer Care directly via the toll-free number on your member ID card.

Does Navitus Health Solutions help with specialty medications?

Yes, Navitus Health Solutions manages specialty medications, often through its wholly-owned subsidiary, Lumicera Health Services. Lumicera operates on a transparent, cost-plus model for specialty drugs, providing personalized support from skilled pharmacists to help manage these complex and often high-cost treatments.