Santa Cruz County Pharmacy Plan
Our Mission: Navitus Health Solutions is a full-service pharmacy benefit company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.
Stewardship of our clients’ programs is not just what we do—it is our top priority. We take great pride in achieving a perfect score on the 2013 Pharmacy Benefit Management Institute (PBMI) customer satisfaction report, which reflects our people-first commitment.
We Share a Clear View to take transparency and full pass-through to new heights to deliver extraordinary value and put financial control in our clients’ hands. Our focus is on improving member well-being and optimizing value—as evidenced by our year-over-year drug trend rate, which is consistently well below the national trend, and outstanding generic fill rate. An extensive suite of customizable PBM services enables us to tailor solutions to meet each client’s specific needs.
Who is Navitus?
Navitus Health Solutions is your Pharmacy Benefits Manager (PBM). A PBM directs prescription drug programs and processes prescription claims by negotiating drug costs with manufacturers, contracting with pharmacies and building and maintaining drug formularies. These cost-saving strategies help lower drug costs and promote good member health.
Whom do I call to request additional prescription drug cards?
You can request replacement cards by calling Gilsbar’s Customer Service Department at 1-888-472-4352. You should receive your new card(s) within 7 to 10 calendar days from the date of your request.
Who do I contact with questions about my pharmacy benefit (such as formulary, claims, participating pharmacies, etc.)?
Your formulary, list of participating pharmacies and other information about your pharmacy benefit can be found on www.navitus.com. You can also call Navitus Customer Care toll-free at 866-333-2757 with questions about your pharmacy benefit.
Where can I find my formulary?
The list of drugs covered by your benefit is available on our Web site at www.navitus.com.
Can I use my health plan card to fill prescriptions at my pharmacy?
Yes, AZLGEBT has opted for combined medical/prescription drug/dental ID card. When filling prescriptions at your pharmacy, you are required to present your AZLGEBT identification card.
When can I refill my prescription?
Your prescription can be refilled when approximately two-thirds or 70% of the prescription has been taken.
How do I fill a prescription when I travel for business or vacation?
If you are traveling for less than one month, any Navitus Network Pharmacy can arrange in advance for you to take an extra one-month supply. A copayment will apply.
Visit www.navitus.com for complete instructions on filling prescriptions while traveling, or contact Navitus Customer Care toll-free at 866-333-2757.
If you are traveling for more than one month, you can request that your pharmacy transfer your prescription order to another network pharmacy located in the area where you will be traveling.
Can prescriptions be mailed to me if I’m outside of the United States?
Prescriptions cannot legally be mailed from any pharmacy in the United States to locations outside of the country, except for U.S. territories, protectorates and military installations.
What are Specialty Drugs?
Specialty medications are an important part of the treatment for many chronic illnesses and complex diseases such as certain cancers, rheumatoid arthritis, multiple sclerosis, HIV and Hepatitis C. These medications require personalized coordination between the member, prescriber and pharmacy. Therefore, these medications are generally filled by a Specialty Pharmacy who can deal directly with the patient’s personal needs.
How do I obtain Specialty Drugs that aren’t available at my local pharmacy?
Navitus works with Lumicera Health Services to offer services with the highest standard of care. You will get one-on-one service from skilled pharmacists. They will answer questions about side effects and give advice to help you stay on course with your treatment. With Lumicera, delivery of your specialty medications is free, and right to your door or prescriber’s office via FedEx.
Local courier service is available for emergency, same-day medication needs. To start using Lumicera, please call toll-free 1-855-847-3553 and they will work with you and your prescriber for current or new specialty prescriptions.
How does the RxCENTS (Tablet Splitting) program work?
The Tablet Splitting program saves you money by breaking a higher-strength tablet in half to provide the needed dose. You will receive the same medication and dosage while purchasing fewer tablets and saving your hard earned dollars.
There are two ways to get started with the Tablet Splitting program:
- Call your doctor and ask them whether tablet splitting is an option for you. He or she can update your prescription with your pharmacy if appropriate.
- Ask your pharmacist to help change your prescription to one that can be split through the Navitus Tablet Splitting program.
Tablet splitting is not required by Navitus, but is simply offered to you as a way to help control costs. If you have any questions, or would like to receive a tablet splitter, please contact Navitus Customer Care toll-free at 1-866-333-2757.
Pharmacy Plan Resources
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Prescription Drug Plan
If you elect medical coverage, prescription drug coverage through Navitus Health Solutions is automatic.
All prescriptions must be filled at a network pharmacy or through the mail-order service. Navitus has a nationwide network of contracted pharmacies which includes chain stores and independent pharmacies. Additionally, Navitus offered a Preferred Pharmacy Network which offers deeper discounts to AZLGEBT, and therefore lower copayments to you.
AZLGEBT Prescription Drug coverage is as follows:
Retail Pharmacy (up to a 30-day supply at participating pharmacies
|Tier 1||$10.00 co-pay||$15.00 co-pay|
|Tier 2||$35.00 co-pay||$40.00 co-pay|
|Tier 3||$75.00 co-pay||$80.00 co-pay|
|Specialty||$75.00 co-pay||$75.00 co-pay|
Retail 90 Pharmacy (up to a 90-day supply at participating pharmacies)
|Tier 1||$25.00 co-pay||$30.00 co-pay|
|Tier 2||$87.50 co-pay||$92.50 co-pay|
|Tier 3||$187.50 co-pay||$192.50 co-pay|
Mail Order Pharmacy (up to a 90-day supply)
|Tier 1||$10.00 co-pay|
|Tier 2||$70.00 co-pay|
|Tier 3||$150.00 co-pay|
Below are descriptions of the Navitus Select Formulary drug tiers:
Tier 1 – Formulary generics and certain low cost brand name drugs
Tier 2 – Formulary brand name drugs and certain higher costs generic drugs
Tier 3 – Non-formulary drugs, both brand and generic
Speciality Drugs – Are biotech drugs to treat chronic, serious, or rare disease. In most cases, these drugs are delivered by injection or infusion requiring complex care, special storage and handling, strict compliance requirements, or extra patient support. Some health conditions are, but not limited to, Crohn’s disease, growth hormone deficience, multiple sclerosis, rheumatoid arthritis, solid organ transplant, and viral hepatitis. Specialty medications are only available through the Navitus Speciality/RX Program Pharmacy.
Additional prescription programs you should be aware of:
Mail Order Services – This program is part of your pharmacy benefit and is voluntary. The Mail Order Service allows you to receive a 90-day supply of maintenance medications.
90 Day at Retail Program – This program is part of your pharmacy benefit and is voluntary. The 90 day at Retail program allows you the convenience of receiving up to a 90 day supply of most medications at participating retail pharmacies. If you get a prescription filled on a regular, recurring basis, talk to your doctor about writing a prescription for a 90 day supply.
For more detailed coverage information, reference the Summary Plan Document or contact your benefits department.