The amount you pay for prescription drugs:
- You pay $5 for Level 1 drugs. These include most generic drugs and some lower-cost brand-name drugs.
- You pay 20% coinsurance up to $50 for Level 2 drugs. These include most preferred, brand-name drugs and some higher-cost generic drugs that are alternatives to brand-name drugs covered at Level 1. These drugs have a higher cost share for members because they generally cost more and have an alternative or equivalent drug covered at Level 1.
- You pay 40% coinsurance up to $150 for Level 3 drugs. These are considered non-preferred, non-covered drugs. These drugs will have alternatives or equivalent drugs covered at Level 1 or Level 2.
- You pay either $50, or 40% coinsurance up to $200 for Level 4 Preferred drugs. These are specialty medications, which are used to treat chronic illnesses and complex diseases, and are very expensive. Members have the opportunity to get these drugs for a $50 copayment through a Specialty Rx Pharmacy Program at Diplomat Specialty Pharmacy (go to the Navitus Member Portal). Level 4 Preferred drugs that are obtained from any other pharmacy are subject to 40% coinsurance with a $200 maximum.
- You pay 40% coinsurance up to $200 for Level 4 Non-Preferred drugs. These are also specialty medications, and like Level 3 drugs, these are technically non-covered drugs that members are provided an opportunity to obtain and pay less than the actual, full cost of the drug. Level 4 Non-Preferred drugs are not eligible for the flat $50 copayment even if purchased through Diplomat Specialty Pharmacy.
Deductibles and Prescription Drug Benefits:
Deductibles do not affect your prescription drug benefits unless you are enrolled in a High Deductible Health Plan (HDHP) option. Deductibles do not apply to prescription drug benefits for non-HDHP options. Find out more online.
Register on the Navitus Website: The Navitus website contains a wealth of information including the most current formulary, your medication history, a pharmacy locator, and other information about prescription drugs and your benefits.
- If you haven’t already registered we encourage you to do so at the Navitus Member Portal. You will need the 8-digit member ID from your Navitus ID card to register.