It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

NAVITUS HEALTH SOLUTIONS — Pharmacy
Toll-Free Customer Care — (866) 333-2757
navitus.com
Diabetic Supply Coverage
Diabetic supplies and glucometers are
covered with a 20% coinsurance. In most
cases this coinsurance applies to your
prescription drug OOPL. Contact Navitus
Customer Care if you have questions about
your copayment applying to the OOPL.
90-Day-at-Retail Program
A 90-day supply of most maintenance
medications can be purchased at your
retail pharmacy. To take advantage of this
program you must have three consecutive
claims already processed for that drug in the
Navitus claims system immediately before the
90-day supply is requested. In addition, your
doctor must write the prescription specifically
for a 90-day supply. Three copayments are
still required. More information can be found
on Navitus’ website or by calling Navitus
Customer Care.
Mail Order Program
Up to a 90-day supply of Level 1 and Level 2
medications can be purchased for only
two copayments through our mail order
service. Some Level 3 medication may also
be available for up to a 90-day supply, but
three copayments will apply. More detailed
information can be found on the Navitus
website; the WellDyneRx website (welldynerx.
com) or by calling Navitus Customer Care. To
register for mail order service, call WellDyneRx
Customer Care toll free at (866) 490-3326, 24
hours a day, seven days a week.
RxCENTS Tablet-Splitting Program
By splitting a higher-strength tablet in half to
provide the needed dose, you receive the
same medication and dosage while buying
fewer tablets and saving on copayments.
Medications included in the program are
marked with “¢” on the Navitus formulary.
Members may obtain tablet splitting devices
at no cost by calling Navitus Customer Care.
Generic Copay Waiver Program
Your first fill of a sample medication through
this program is free. Medications included in
this program are marked with “GW” on the
Navitus formulary. To try this program, your
doctor needs to write a prescription for one of
the program medications. If it is your first time
filling this prescription, you get the medication
at no cost.
Specialty Medication Program
(Self-Injectables and Specialty Medications)
If you are on a specialty medication, the
Navitus SpecialtyRx Program is offered
through a partnership with Diplomat
Specialty Pharmacy to help coordinate
members’ specialty pharmacy needs.
Prescriptions for formulary specialty
medications, marked with “ESP” in the
formulary, that are filled at Diplopmat receive
a reduced $15 copayment. The reduced
copayment does not apply to covered,
non-formulary specialty medications. To
begin receiving your self-injectable and other
specialty medications from the specialty
pharmacy, please call Navitus SpecialtyRx
Customer Care at (877) 651-4943 or visit
diplomatpharmacy.com.
Coordination of Benefits
Coordination of benefits applies when,
as determined by the order of benefit
determination rules, you have primary
coverage under another policy and Navitus is
your secondary coverage. All claims need to
be submitted to your other policy first. Navitus
covers the remaining cost of any covered
prescriptions up to the allowed amount under
your policies. Coordination of benefits does
not guarantee that all of your out-of-pocket
costs will be covered.
Decision Guide Page 69