Prescription

Navitus Health Solutions 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.

In-Network Pharmacies

For a full list of participating pharmacies go to navitus.com and login to your account.

Formulary

The Formulary tells you which prescriptions are covered and which tier a covered prescription falls under. To view your formulary go to navitus.com and login to your account.

cost compare

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

90-Day Supply of Medications

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.

specialty pharmacy

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.

Benefit Structure

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*	$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

*$0 Preventive products apply to certain medications (as defined by the Affordable Care Act (ACA) and select medications. See the formulary for a listing of covered products.

Specialty Benefits

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 Speciality Medications $0 copayment for Generic Specialty Medications	50% coinsurance	50% coinsurance	N/A	Only if filled at Preferred Specialty Pharmacy

Medicare Retirees enrolled in the Navitus MedicareRx plan will have a $50 copayment for Specialty Medications (brand name and generic) when filling at the Preferred Specialty Pharmacy.