Drugs will be filled as generics when acceptable generic equivalents are available. Media type media type all case study conferences and events ebook in the news infographic press release whitepaper. Specialty pharmacy navitus specialtyrx the navitus specialtyrx pharmacy program is offered through a partnership with diplomat pharmacy. 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. Please fill out all applicable sections on both pages completely and legibly. Navitus program pharmacy enrollment dme enrollment star chip star kids p. 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. 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. Faxing a fully completed and signed medication reque st form to navitus health solutions 8558789209. Navitus medicarerx will generally cover the drugs listed in our.
This is where you can find information about your pharmacy benefit plan. Present your current sisc id card to the pharmacist. This resource is meant to help you keep uptodate with details about your benefit. You will be reimbursed directly for covered services up to the navitus contracted amount. P rescription d rug p rior a uthoriz a tion r equest f orm planmedical group name.
The completeness of the information you provide has an impact on how quickly your request can be considered. Navitus health solutionspharmacy 18663332757tollfree customer care pharmacynavitus health solutions. Please submit comments or suggestions regarding the formulary to. Iehp medical member services 800 4404347 800 7184347 tty iehp dualchoice member services 877 2734347 800 7184347 tty iehp 24. It is also here to give you useful information about drugs that may have been prescribed to you. Formulary your formulary is evaluated on an ongoing basis, and could change. All members receive a new id card when they enroll. The prescription drug benefit is a multilevel formulary i. The st code would be listed next to the medication name on the formulary. The texas drug code index includes programspecific formularies for the following programs. The pharmacist usually tells you this information when you fill your next prescription.
Chief human resources officer, west tennessee healthcare. Contacting navitus at 8442689786 and providing all necessary information requested. Dispensing pharmacy fax completed form to navitus for approval. We understand that as a health care provider, you play a key role in protecting the health of our members. If you have more questions about the formulary or your cost. Please refer to your navitus formulary for a complete list of covered products. Please click on the link s below to view the formulary documents. Navitus covers the remaining cost of any covered prescriptions up to the allowed amount under your state plan. Non formulary drugs require prior authorization or may be subject to clinical edits. A drug formulary is a list of generic and brand name drugs identified as preferred or best in class based on overall value i. A member can make a request for reimbursement by completing the direct member claim form pdf. Audience type audience type all employers hospitals health plans pharmacies consultants government unions associations. Any member services specialists mss can take confirmation over the phone from the pharmacy or providers office that step therapy criteria have been met.
Please sign in by entering your npi number and state. Determine the copay or coinsurance percentage using the benefit plan design and the formulary coverage level. Navitus medicarerx pdp 2020 formulary list of covered drugs. Please sign in by entering your npi and ncpdp numbers. Coordination of benefits does not guarantee that all of your outofpocket costs will be covered. Navitus pharmacy benefit book oakland county, michigan. If the therapy requested is not well established, references are helpful. The swhp group value formulary is a tiered formulary, meaning there are different copayments for different levels of drugs. Not all prescription drugs are covered by the vanderbilt health plan.
Prior authorization is genera lly not available for drugs that are. 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. Maintenance medication retail90 and mail order tac hebp and navitus offer members a savings of. Navitus made my job so much easier and less worrisome. State of wisconsin group health insurance program formulary cont. Members can access navitus member portal navigate for members to view the current formulary listing. Hpms approved formulary file submission id 00020268, version number 8. Navitus health solutions reimbursement form forms can be mailed or faxed to navitus health solutions, using the contact information below. 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. Customer care can be reached 24 hours a day7 days a week, except thanksgiving and christmas. 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. The formulary includes preferred drugs covered under your prescription benefit. You can also access these documents on navigate for members online at.
The most updated version of this document, as well as a complete formulary listing, are available at. If you have more questions about the formulary or your cost share. Auto coverage liability coverage property coverage workers compensation file a claim find your tac rmp team. Formulary exception request depending on the nature of your request, pharmacy services may need to obtain additional information. If you have questions about your formulary, please contact navitus medicarerx pdp customer care. Pharmacynavitus health solutions tollfree customer care18663332757.
Why should i use navitus specialtyrx for my specialty drug needs. Below are the medications included on your preventive drug list. They assisted us in ensuring our significant formulary change went smoothly. Navitus customer care 18663332757 open 24 hours a day, 7 days a week or visit us online at.
The complete formulary can be found on our website. All requests for member reimbursement should be directed to the following address. The formulary will list the coverage level for each drug. Navitus or badgercare members whose drug benefit is administered by forwardhealth. Products are identified with a sp in the special code column. If you have more questions about the formulary or your cost share, please contact navitus customer care. Texas prior authorization program clinical criteria xifaxan rifaximin. Some prescription drugs require prior authorization from navitus health solutions before the prescription can be filled. We will generally cover the drugs listed in our formulary as long as the drug is medically necessary and the prescription is filled at a network pharmacy. Go to click on the link for members and then click on the link for member login. A formulary is a list of covered drugs selected by navitus medicarerx in. To submit a claim for reimbursement of prescription medications, please click on the navitus form below and follow the provided steps within the document. The financial savings we experienced have exceeded what we anticipated.
Please enter the information requested below exactly how it appears on your card. Navitus uses the nppes database as a primary source to validate prescriber contact 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. Please click on the links below to view the formulary documents. This requirement applies to all nongrandfathered plans with an effective date on or after august 1, 2012. Quick reference formulary community health choice ers. Who is navitus health solutions and how do i contact them. We are looking forward to serving district council 1707 local 95 head start employees welfare fund. Navitus renewed as pbm for wisconsin etf by unanimous vote of group insurance board. The pharmacist usually tells you this information when you. The formulary below lists prescription drugs that are covered by navicare hmo snp and navicare sco. These medications help protect against or manage some high risk. Navitus medicarerx member portal use this portal to access the most up to date formulary, pharmacy directory, and. Also, not all medications may be covered on your formulary.
Texas medicaid vendor drug program respiratory syncytial. Navitus participating pharmacies network listing final. Nonformulary drugs require prior authorization or may be subject to clinical edits. Texas childrens health plans network of pharmacies. The medicare part d formulary file is a suite of three sub files. Online submission is only available for nonpreferred prior authorization. Treat navitus documents that relate to pricing, contracts, programs. Quick reference formulary state of montana benefit plan. Formulary means the list of fdaapproved covered products developed by navitus pharmacy and therapeutics committee, subject to clients plan guidelines and coverage decisions.
Navitus will provide an authorization number, specific for the medical need, for all approved requests. Formulary prescription drug list the navitus formulary list is on the navitus member website. Navitus believes that effective and efficient communication is the key to ensuring a strong working relationship with our participating pharmacies. Refer to your formulary after logging in to navigate for members portal to find out which drugs are covered. Some covered prescription drugs have additional requirements and. Calls to these numbers are free, and available 24 hours a day, 7 days a week, except thanksgiving and christmas day. Navitus specialtyrx helps members who are taking medications for certain chronic. Reimbursement for drugs will be limited to those obtained while living or traveling outside of the united states and will be subject to the same restrictions and coverage limitations as set forth in this evidence of coverage document.
Provider annual newsletter texas childrens hospital. The formulary is also available on t he formulary search mmit application for mobile devices. Direct member reimbursement claim form pdf compound claim form pdf foreign claim form pdf complete all the information on the form. Your health plan is making an effort to reduce your health care costs by giving you tools to help you stay healthy and productive. Navitus medicarerx customer care 18662703877 tty users, please call 711. Navitus has been hired by andrews university to manage the. Navitus medicare rx where can i find my formulary information. Navitus does not send separate notices if a brandname drug becomes available as a generic drug.
Quick reference formulary this document is subject to change. The contact information for navitus can be found on the back page titled resources, or 18663332757. State of wisconsin group health insurance program formulary. The pharmacist will fill the prescription for up to a 30 day supply of medication or possibly up to a 90 day supply, if applicable. Therapeutic classes are a group of similar drugs and have the same effect in the body. The navitus specialtyrx pharmacy program is offered through a partnership with diplomat pharmacy.
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