Prescription - Benefits Division
Prescription Drug Plan
Navitus Contact Information Lumicera Contact Information
Navitus Health Solutions (Navitus) is the pharmacy benefit manager and processes pharmacy claims for the State Plan.
For complete details about your prescription drug benefits, refer to the Wrap Plan Document.
Eligibility
State Plan medical coverage includes prescription drug coverage for all enrolled employees, legislators, retirees, COBRA participants, and their eligible dependents (spouse, domestic partner, and/or children).
If you enroll as a State Plan Retiree, you and your spouse or domestic partner and/or dependent’s Medicare Part D prescription drug coverage will be provided by the State Plan. If you are enrolled in 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 your State Plan coverage (medical, prescription, vision, dental, and life) will be terminated.
Find an In-Network Retail Pharmacy and Compare Costs
For a full list of in-network retail pharmacies and to compare drug costs, go to navitus.com.
For the Medicare retiree in-network retail pharmacy list, go to medicarerx.navitus.com.
Preferred Specialty Pharmacy
Lumicera is the State Plan's preferred specialty pharmacy for specialty medications (drugs that require special administration). If you fill your specialty medication through a pharmacy other than Lumicera, you may pay significantly more, and those costs do not count toward your annual prescription out-of-pocket maximum.
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.
For the Medicare retiree formulary, go to medicarerx.navitus.com.
Save with a 90-Day Supply of Your Medication
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 retail pharmacy or mail order pharmacy. We pass those savings on to you by reducing your copay. Options for 90-day supply include:
Specialty medications and controlled substances are limited to a 34-day supply.
My Health Navigator
My Health Navigator 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. Learn more below.
Big Sky Rx Program
The Big Sky Rx Program is dedicated to helping Medicare clients pay for Medicare-approved prescription drug insurance premiums. Learn more at dphhs.mt.gov/SLTC/aging/BigSky, email BigSkyRx@mt.gov, or call (866) 369-1233 (TTY 711).
| Benefit Structure | Retail In-Network Pharmacy (34 Day Supply) | Retail Out-of-Network Pharmacy (10 Day Supply) | In-Network Retail or Mail Order Pharmacy (90 Day Supply) | Applies to Prescription Maximum Out-of-Pocket |
|---|---|---|---|---|
| $0 preventive products* | $0 copay | $0 copay | $0 copay | Yes |
| Tier 1 - Preferred generics and some lower cost brand products | $15 copay | $15 copay | $30 copay | Yes |
| Tier 2 - Preferred brand products and some high-cost non-preferred generics | $50 copay | $50 copay | $100 copay | Yes |
| Tier 3** - Non-preferred products (may include some high-cost non-preferred generics) | 50% coinsurance | 50% coinsurance | 50% coinsurance | No |
| Tier 4 - Speciality drugs filled at Preferred Specialty Pharmacy |
$200 copay for brand specialty medications $0 copay for generic specialty medications
|
N/A | N/A |
Yes
|
| Tier 4 - Speciality drugs filled at Preferred Speciality Pharmacy (Medicare retirees only) |
$50 copay for brand specialty medications $0 copay for generic specialty medications |
N/A | N/A |
Yes |
| Tier 4 - Speciality drugs filled at non-preferred pharmacy |
50% coinsurance |
N/A | N/A |
No |
*$0 preventive products apply to certain medications (as defined by the Affordable Care Act [ACA]) and other select medications. See the formulary for a list of $0 covered products.
**Does not apply to maximum out-of-pocket
Prescription Maximum Out-of-Pocket
- $1,800 per individual
- $3,600 per family
Separate from medical maximum out-of-pocket. Maximum out-of-pocket is based upon a Plan Year, which is January 1 through December 31.
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 affecting my life before.”
Note: My Health Navigator does not dispense medications, allowing 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
