Health Care & Benefits Division

Prescription Plan

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. 

 

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

 

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.

The Big Sky Rx Program is dedicated to helping Medicare clients pay for Medicare approved prescription drug insurance premiums.

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.

Prescription Resources

 

 

Navitus-Lighthouse-PBR-Color-002_1.jpg

 

Employees, Legislators, Non-Medicare Retirees:

Hours: 24 hours per day  l  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

 

Lumicera Logo

Preferred Speciality Pharmacy 

Phone: (855) 847-3553

TTY user: 711

Email: contact@lumicera.com

Website: lumicera.com 

 

Big Sky RX logo

Medicare Retiree Prescription Cost Assistance

Phone: (866) 369-1233

TTY user: 711

Email: bigskyrx@mt.gov

Website: bigskyrx.mt.gov

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