Prescription - Benefits Division
Prescription Drug Plan
Navitus Health Solutions
Navitus is the Pharmacy Benefit Manager for the State of Montana Benefit Plan (State Plan).
Navitus is committed to lowering drug costs, improving health and delivering superior service. To access more information about Navitus or to get information about the prescription drug program, see below.
If you enroll as a State Plan Retiree, you and your spouse/domestic partner and/or dependent’s Medicare Part D prescription drug coverage will be provided by the State Plan. If you are enrolled on State Plan coverage, you may not purchase Medicare Part D coverage with any other provider. If you enroll in other Medicare Part D coverage, all of your State Plan coverage (medical, prescription, vision, dental, and life) will be terminated. The Big Sky Rx Program is dedicated to helping Medicare clients pay for Medicare approved prescription drug insurance premiums.
Visit navitus.com for access to tools that compare drug costs at participating pharmacies.
Medicare retirees should use medicarerx.navitus.com for access to tools that compare drug costs at participating pharmacies.
You can get a three month (90-day) supply of some maintenance medication for a two month copay!
The State Plan pays less for many medications when a 90-day supply is filled at an in-network retailer or preferred mail order pharmacy. We pass those savings on to you by reducing your copay.
Preferred 90-Day Supply Options
- Most in-network retail pharmacies (refer to network directory at navitus.com)
- Costco (membership not required)
- Ridgeway
Please note controlled substances are only available at a 34-day supply.
Lumicera Health Services is the State Plan’s preferred pharmacy to handle specialty medications (drugs that require special administration). Delivery of your specialty medications is free, and direct to your door or prescriber's office via FedEx.
Using a pharmacy other than Lumicera for specialty medications could cost significantly more and does not accumulate toward your prescription annual Max Out-of-Pocket.
The tiers on the formulary are structured as follows:
- Tier 0: Certain preventative medications.
- Tier 1: 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 the member.
- Tier 2: Preferred brands and select generics that are less cost effective.
- Tier 3: Non-preferred brands and generics that provide the least value because of high cost or low clinical value, or both.
Prescription Max Out-of-Pocket: Individual $1,800 / Family $3,600
| Benefit Structure | Retail Network Pharmacy (34 Day Supply) | Retail Out-of-Network Pharmacy (10 Day Supply) | Retail or Mail Order Network Pharmacy (90 Day Supply) | Applies to Prescription Max Out-of-Pocket |
|---|---|---|---|---|
| $0 preventive products* (see note below table) | $0 copayment | $0 copayment | $0 copayment | Yes |
| Tier 1 - Preferred generics and some lower cost brand products | $15 copayment | $15 copayment | $30 copayment | Yes |
| Tier 2 - Preferred brand products and some high cost non-preferred generics | $50 copayment | $50 copayment | $100 copayment | Yes |
| Tier 3 - Non-preferred products (may include some high cost non-preferred generics) | 50% coinsurance | 50% coinsurance | 50% coinsurance | No |
| Benefit Structure | Preferred Specialty Pharmacy (34 Day Supply) | Retail Network Pharmacy - Includes Non-preferred Specialty Pharmacies (30 Day Supply) | Retail Out-of-Network Pharmacy | Network Mail Order Pharmacy (90 Day Supply) | Applies to Prescription Max Out-of-Pocket |
|---|---|---|---|---|---|
| Tier 4 - Specialty Drugs |
$200 copayment for Brand Specialty Medications $0 copayment for Generic Specialty Medications |
50% coinsurance | 50% coinsurance | N/A | Only if filled at Preferred Specialty Pharmacy |
Employees, Legislators, Non-Medicare Retirees:
Hours: 24 hours per day, 7 days per week
Phone: (866) 333-2757 (toll-free), TTY (toll-free) 711
Mailing Address:
Navitus Health Solutions
P.O. Box 999
Appleton, WI 54912-0999
Website: navitus.com
Mobile App: Navitus Health Solutions
Medicare Retirees:
Navitus MedicareRx Customer Care
Hours: 24 hours per day, 7 days per week
Phone: (866) 270-3877 (toll-free), TTY (toll-free) 711
Mailing Address:
Navitus Medicare Rx Customer Care
P.O. Box 1039
Appleton, WI 54912-1039
Website: medicarerx.navitus.com
Preferred Specialty Pharmacy
Phone: (855) 847-3553
TTY user: 711
Email: contact@lumicera.com
Website: lumicera.com
Medicare Retiree Prescription Cost Assistance
Phone: (866) 369-1233
TTY user: 711
Email: bigskyrx@mt.gov
Website: dphhs.mt.gov/SLTC/aging/BigSky
My Health Navigator (formerly Hometown MTm) is a State of Montana sponsored program available to State Plan members at no additional charge. They help members identify the safest, most effective and least costly medications, control health issues, and navigate a complicated healthcare system.
My Health Navigator can help you:
- Minimize Prescription Costs
- Get Answers About Your Health
- Control Healthcare Expenses
- Simplify Medication Management
- Improve Overall Health
- Manage Long-Term and Chronic Conditions
- $0 copay diabetic test strips (as part of the My Health Navigator Diabetes Program
- Reduced copay on some asthma medications and $0 copay peak flow meter and holding chamber (as part of the My Health Navigator Asthma Program
Resources
Patient Testimonial
“This program has changed my life. I would have never started on the Advair I was prescribed without the discount and education you provided about how the Advair would help my breathing. I have had asthma for over 30 years and it was not until I started taking my Advair correctly that I realized how much my asthma had been effecting my life before.”
Note: My Health Navigator does not dispense medications, which allows State Plan members to continue using their current pharmacy.
Vendor & Partnership Information
Phone: (406) 780-8018
Email: info@myhealthnavigator.net
Website: myhealthnavigator.net
Working in partnership with
