Navitus uses the nppes database as a primary source to validate prescriber contact information. This document contains information about the drugs we cover in this plan hpms approved formulary file submission id 00019362, version number 39 this formulary was updated on 12012019. Calls to these numbers are free, and available 24 hours a day, 7 days a week, except thanksgiving and christmas day. All formulary alternatives must be tried and failed or contraindicated. Summary of formulary benefits the information in this document will help you understand the prescription drug benefits offered under this plan and to compare these benefits to those offered by other plans. Please refer to your navitus formulary for a complete list of covered products. Navitus health solutionspharmacy 18663332757tollfree customer care pharmacynavitus health solutions. With navitus mail order service, prescriptions are delivered right to your door no need to stand in line at the pharmacy. Coordination of benefits does not guarantee that all of your outofpocket costs will be covered.
Your formulary preferred drug list is available in navigate for members. Navitus has contracted with pharmacies in texas to provide pharmacy access to texas managed medicaid starchip members. Please sign in by entering your npi number and state. Every year, over seven million transcription errors occur nationwide. Summary of formulary benefits how to find information on. Navitus medicarerx pdp summary of benefits 2020 health care. The texas medicaid formulary contains all formulary products, including those on the preferred drug list, available to people enrolled in medicaid. Navitus participating pharmacies network listing final. Formulary exception request depending on the nature of your request, pharmacy services may need to obtain additional information. Navitus medicarerx pdp 2020 formulary list of covered drugs c and o employees hospital association please read. We understand that as a health care provider, you play a key role in protecting the health of our members.
Navitus medicarerx pdp 2020 formulary list of covered. Navitus medicarerx will generally cover the drugs listed in our. Please click on the links below to view the formulary documents. If the therapy requested is not well established, references are helpful. Navitus partner portal logon navitus health solutions. Please always refer to your navitus formulary for a complete list of covered products. Why should i use navitus specialtyrx for my specialty drug needs. Who is navitus health solutions and how do i contact them.
The coverage associated with each drug is noted on the formulary. No, you are required to present a navitus id card to the pharmacy when you fill a prescription. The complete formulary can be found on our website. This document contains information about the drugs we cover in this plan hpms approved formulary file submission id 00020268, version number 11 this formulary was updated on 03012020. Navitus medicarerx pdp pharmacy directory 2017 airconditioning and refrigeration industry health. The prescription drug benefit is a multilevel formulary i. A drug formulary is a list of generic and brand name drugs identified as.
Drugs that include the special code pa on the formulary require prior approval. The vanderbilt health plan includes a prescription drug benefit managed by navitus health solutions. Directory, and formulary on the navigate for members portal at. This tier typically contains preferred drugs and some generic drugs. Quick reference formulary community health choice ers. Any member services specialists mss can take confirmation over the phone from the pharmacy or providers office that step therapy criteria have been met. When you have a concern about a benefit, claim or other service, please call navitus. If you wish to file a grievance with navitus medicarerx pdp, you or your designated representative may call navitus medicarerx pdp customer care. For coverage consideration, all covered alternatives must be tried and failed or contraindicated. This document is ed by navitus health solutions and may be. Prescription drug benefit benefits human resources.
The completeness of the information you provide has an impact on how quickly your request can be considered. Covered outpatient prescription drugs prescribed by a prescriber in connection with a covered illness or. You can ask navitus medicarerx to make an exception to these restrictions or limits or for a list of other, similar drugs that may treat your health condition. How does navitus decide which prescription drugs should require prior authorization. See the section, how do i request an exception to the navitus medicarerxs formulary. Outpatient prescription drug formulary legend tier 1 firsttier drugs generally have the lowest costshare. Generally, the state plan only covers drugs, vaccines, biologicals and medical supplies that are covered under the medicare prescription drug benefit part d and that are on the formulary. Medicaid childrens health insurance program chip children with special health care needs cshcn services program healthy texas women htw program kidney health care khc program managed care organizations are required to adhere to the medicaid and chip formularies. If you do not know the correct spelling, you can start your search. Specialty pharmacy navitus specialtyrx the navitus specialtyrx pharmacy program is offered through a partnership with diplomat pharmacy. Navitus has been hired by andrews university to manage the ever increasingly complicated prescription benefit program. Navitus has contracted with pharmacies in texas to provide pharmacy access to texas managed medicaid starchipstar kids members. This is a large document, but you can search quickly and easily by entering ctrl f and it will then display a find box for you to type in the name of the drug you want to locate. Navitus medicarerx customer care 18662703877 tty users, please call 711.
Information in this summary will help you compare the value and scope of formulary benefits. Navitus made my job so much easier and less worrisome. Lipitor is no longer covered kalydeco added to tier 2 and requires a prior. This is where you can find information about your pharmacy benefit plan. Chief human resources officer, west tennessee healthcare. Please contact navitus customer care tollfree at the number listed on the members pharmacy benefit member id card for any inquiries related to the status of a pharmacy or to find a participating pharmacy near the member. Navitus medicarerx member portal use this portal to access the most up to date formulary, pharmacy directory, and. P rescription d rug p rior a uthoriz a tion r equest f orm instructions. Quick reference formulary multicare better connected formulary. If you have questions about your formulary, please contact navitus medicarerx pdp customer care. The contact information for navitus can be found on the back page titled resources, or 18663332757. Navitus covers the remaining cost of any covered prescriptions up to the allowed amount under your state plan.
Also included is information regarding which drug products are subject to prior authorization andor quantity limits and drugs that are part of the rxcents tablet splitting program. Navigate for prescribers offers 247 access to plan specifications, formulary and prior authorization forms, everything you need to manage your business and provide your patients the best possible care. Formulary means the list of fdaapproved covered products developed by navitus. Please fill out all applicable sections on both pages completely and legibly. Navitus will handle allprovider prescriber and pharmacy calls and is available 247365 except thanksgiving and christmas from 8 am to 6 pm central time. A formulary is a list of brand and generic drugs which are covered by your plan. You can call navitus customer care tollfree at 8663332757 with questions about your formulary or look online at.
Idealcare by sendero health plans 2020 formulary overview. Included in this mailing is information on how to access your evidence of coverage, pharmacy. Please sign in by entering your user name and password. Coverage of medications, including those not otherwise identified by. They assisted us in ensuring our significant formulary change went smoothly. Pbmplan sponsor relationships in a postrebate world. Plavix is no longer covered atorvastatin moved to tier 1. When this pharmacy directory refers to we, us, our, plan, or our plan, it means navitus medicarerx pdp. Navitus formulary updates the following changes have taken effect recently or will take effect on july 1, 2012 for most clients utilizing the navitus formulary. Looking for a fast, easy and convenient way to receive your maintenance medications. The nova scotia formulary details which drugs and supplies are benefits under the nova scotia seniors pharmacare program, family pharmacare program, diabetes assistance program, community services pharmacare programs and drug assistance for cancer patients. Navitus will provide an authorization number, specific for the medical need, for all approved requests. A formulary is a list of covered drugs selected by navitus medicarerx in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.
This resource is meant to help you keep uptodate with details about your benefit. For more recent information or other questions, please. Quick reference formulary this document is subject to change. Maintenance medication retail90 and mail order tac hebp and navitus offer members a savings of onethird of the copay for a 90day prescription. Drugs will be filled as generics when acceptable generic equivalents are available. Members may file a grievance for such issues as the behavior of a pharmacist or excessive wait times at the pharmacy. Navitus believes that effective and efficient communication is the key to ensuring a strong working relationship with our participating pharmacies. Navitus believes that effective and efficient communication is the key to ensuring a strong working relationship with our prescribers. Navitus ranked a top pbm in pbmi customer satisfaction survey four years running. The prescriber mu st provide information to support the appeal on the basis of medical necessity. Maintenance medication retail90 and mail order tac hebp and navitus offer members a savings of onethird of the co pay for a 90day prescription.
Tac prescription benefits texas association of counties. To enroll in mail order service by mail, please use the. Instructions for costco mail order service pdf tablet splitting for certain drugs that come in tablet form and are identified as appropriate by navitus clinical team, members can save money by filling a prescription for a higher dosage, then splitting the tablet to essentially double the quantity of medication received. We call the pharmacies on this list our network pharmacies because we have made arrangements.
Navitus medicarerx pdp 2020 formulary list of covered drugs. The st code would be listed next to the medication name on the formulary. These guidelines are based on clinical evidence, prescriber opinion and fdaapproved labeling information. The texas managed medicaid starchipstar kids formulary, including the preferred drug list and any clinical edits, is defined by the texas vendor drug program. Entering the incorrect medication quantity increases health care costs and. Quick reference formulary multicare better connected. Navitus medicarerx will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a navitus. Please sign in by entering your npi and ncpdp numbers. Navitus medicare rx where can i find my formulary information. Customer care can be reached 24 hours a day7 days a week, except thanksgiving and christmas. Prior authorization is genera lly not available for drugs that are. Navitus prior authorization and exception to coverage october 2016.
The texas drug code index includes programspecific formularies for the following programs. Tier 2 secondtier drugs will have a higher costshare than firsttier drugs. Navitus as well as those currently practicing in the community. Employer groups part d formulary 2019 formulary 2019 formulary list of covered drugs please read. Thats why we work hard every day to take the unnecessary costs out of. The most updated version of this document, as well as a complete formulary listing, are available at. The financial savings we experienced have exceeded what we anticipated. This document contains information about the drugs we cover in this plan hpms approved formulary file submission id 00020268, version number 8 this formulary was updated on 10012019. A complete version of the navitus formulary, as well as information. Not all prescription drugs are covered by the vanderbilt health plan. To get updated information about the drugs covered by. The drugs on the formulary are selected by navitus medicarerx with the help of a team of doctors and pharmacists.
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