Meet Navitus 2022 Open Enrollment Vendor Q&A Webinar - This session will be recorded for records retention purposes, but will not be shared publicly
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Meet Navitus
2022 Open Enrollment Vendor Q&A Webinar I
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This session will be recorded for records retention purposes, but will not be shared publicly
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Agenda Ground Rules & Introductions Vendor Highlights Q&A Session Wrap-Up & Close
Welcome • ETF is hosting a series of webinars throughout the 2022 open enrollment period • Today’s Q&A session is intended to provide the same personal interaction with a vendor as a benefit fair – from the comfort of your own home or office
Ground Rules
Please mute yourself
During this session, we ask that only moderators
and health plan representatives engage in active
discussion
Please mute yourself if not actively speaking
Enter all questions via the chat function
No personally identifiable information (PII) or
protected health information (PHI) allowed
All general, vendor-appropriate questions are
welcome
Introductions • ETF moderator(s) • Vendor attendee(s)
State of Wisconsin Group Health Insurance Program It’s Your Choice - Open Enrollment
Who is Navitus?
Navitus Health Solutions is a pharmacy benefit manager (PBM). A
PBM processes and pays prescription drug claims for its members. It
contracts with pharmacies and builds and maintains drug
formularies. A PBM also negotiates discounts and rebates with drug
manufacturers.
Navitus provides cost-effective prescription drug benefits for our
clients and their members. Our mission is to improve member health
and minimize their out-of-pocket costs. Navitus also strives to deliver
superior customer service.
Navitus’ primary call center is based on Appleton. Secondary call
center in Austin, TX. Corporate office is in Madison. Additional office
in Phoenix, AZ.
1 ConfidentialWhat is a Formulary?
A formulary is a list of covered medications offered to State of
Wisconsin Group Health Insurance Program members.
A group of independent health care professionals (Pharmacy &
Therapeutics Committee) reviews medications on your formulary to
ensure they have high clinical value, regardless of their pricing. This
means these products provide therapeutic value, are effective, and
have manageable side effects.
In the past, generic medications were typically the lowest-cost
options for prescription medications. That is not always the case
today.
2 ConfidentialFormulary Level Placement
Navitus has organized its formulary in a way that provides the best
value to our clients and members. The levels on the State of
Wisconsin Group Health Insurance Program formulary are structured
as follows:
• Level 1: Includes most low-cost, high value generics and select brands
that provide high clinical value. These products are the lowest-net cost
for the plan and the lowest copayment for members.
• Level 2: Includes preferred brands and select generics that are less cost
effective.
• Level 3: Includes non-preferred brands and generics that provide the
least value because of the high cost, low clinical value, or both.
• Level 4: Specialty medications
3 ConfidentialCopays and Drug Pricing
Copays for medications vary based upon the formulary level of the
medication, day supply of medication being dispensed, and the
pharmacy being utilized.
Pricing of medications can vary by pharmacy. As with any service or
good purchased by a consumer, medications are not priced the
same at all pharmacies.
Online Cost Compare Tool is available on Navitus Member Portal for
Non-Medicare participants. Navitus Customer Care is also available
to assist all members in locating potentially more cost effective
pharmacies.
4 ConfidentialWays To Help Reduce Costs
Serve You DirectRx Mail Order
• Obtain 3 months of medication for 2 copays
• Based in Milwaukee
• Easy to enroll and transfer prescriptions by phone
90 Day Supply at Retail
• Pharmacies offer deeper discounts for a 90 day supply vs 30 day supply.
Depending upon medication, member copays may be the same
however the cost paid by State of Wisconsin Employer Group Health
Insurance Program may be less.
5 Confidential2022 Non-Medicare Benefit Changes
Level 4 Out of Pocket Limit (OOPL) no longer applies for Non-High
Deductible Health Plan. Level 4 copays will continue to apply to
Maximum Out of Pocket.
Option for Continuous Glucose Monitors (CGM) to be filled on
pharmacy benefit
• Covered at Level 3 with Prior Authorization (PA)
FreeStyle Libre
Dexcom G6
6 ConfidentialContacts
Navitus Customer Care
• Available 24 hours a day, 7 days a week (Except Thanksgiving and
Christmas)
• Non-Medicare: 866-333-2757
• MedicareRx: 866-270-3877
Serve You DirectRx Mail Order
• 800-481-4940
− Monday-Friday 7:30am-9:00pm, Saturday, 8:00am-6:00pm, Sunday 9:00am-
3:00pm
− Pharmacists available 24 hours a day, 7 days a week
• www.serve-you-rx.com/navitus
7 ConfidentialAdditional Contacts
Navitus Texting Program
• Text Keyword SMART to 35385 to receive a link to enroll into the
Navitus Texting Program.
Navitus Member Portal:
• Non-Medicare: www.navitus.com
• MedicareRx: www.medicarerx.navitus.com
Public Facing Website: www.etf.benefits.navitus.com
Navitus Mobile App
• Visit Google Play Store or Apple Store and download Navitus Mobile
App
8 ConfidentialThank You.
NAVITUS
PHARMACY BENEFITS REINVENTED™
This document is to be considered confidential and proprietary.
© 2019 Navitus Health Solutions, LLC. All Rights Reserved.Q&A Session
Enter all questions via the chat
function
No PII/PHI allowed
All general, vendor-appropriate
questions are welcomeQ&A Session – Time to Wrap Up
Time for one last question…Member Resources ETF website Health landing page – etf.wi.gov/health Important Changes for 2022 State employees Local employees – same for all Local Program Options See meeting materials for PDF versions Health Plan and Vendor contact information 2022 Decision Guides
2-minute overview of 2022 changes to health
2022 Open benefits
Enrollment Applies to all members
Preview Video Available to view here: etf.wi.gov/video/etf-2022-
open-enrollment-preview2022 Open Enrollment Webinars
ETF Benefit Webinars Benefit Vendor Q&A
• Throughout open enrollment Webinars
• Health Insurance & Pharmacy • All health plans and vendors
Benefits for Active Members participating
• Health Insurance & Pharmacy • Throughout open enrollment
Benefits for Retirees
• Dental & Supplemental • Registration required
Programs • No PII/PHI permitted
• See ETF website for session details
• Wellness Program and to register
• Pre-Tax Savings Accounts • Open Enrollment Health
(State only) Webinars
• Open Enrollment Vendor Q&A
WebinarsEvaluation Survey You will receive an evaluation survey following this session Please take a few minutes to complete the survey
Thank You!
We appreciate your attendance today, as well as the
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cooperation of our health plans and vendor partners
608-266-3285
wi_etf etf.wi.gov ETF E-mail Updates
1-877-533-5020You can also read
