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City of Avondale Pharmacy Benefits

Information on City of Avondale pharmacy plans, summary of benefits, vendor links and forms.

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Who is Navitus?

Navitus Health Solutions is your Pharmacy Benefits Manager (PBM). A PBM directs prescription drug programs and processes prescription claims by negotiating drug costs with manufacturers, contracting with pharmacies and building and maintaining drug formularies. These cost-saving strategies can help lower drug costs and promote good member health.

Who do I call to request additional cards?

You can request replacement cards from AmeriBen by calling Customer Care toll-free at (855) 350-8699.   You should receive your new card within 7 to 10 calendar days from the date of your request.  You may also access a digital ID card through the MyAmeriBen Mobile App, or you can print an ID card through the MyAmeriBen website at www.MyAmeriBen.com.

Who do I contact with questions about my pharmacy benefit (such as formulary, claims, participating pharmacies, etc.)?

Your formulary, list of participating pharmacies and other information about your pharmacy benefit can be found on www.navitus.com.  You can also call Navitus Customer Care toll-free at (866) 333-2757 with questions about your pharmacy benefit.

Where can I find my formulary?

The list of drugs covered by your benefit is available on the Navitus website at www.navitus.com.

Can I use my health plan card to fill prescriptions at my pharmacy?

Yes, Navitus has provided you with a combined medical/prescription drug ID card.  When filling prescriptions at your pharmacy, you are required to present a Navitus ID card.

When can I refill my prescription?

Your prescription can be refilled when approximately two-thirds or 70% of the prescription has been taken.

How much will I pay at the pharmacy?

Your prescription coverage offers 4 copayment levels: Generic, Preferred Brand, Non-Preferred Brand and Specialty; prescriptions purchased at a non-preferred pharmacy will be subject to an additional $5 co-payment.  Additionally, your plan offers discounted copayments if you fill your maintenance prescriptions, prescriptions that you take on a daily basis, for up to a 90-day supply.  The copayment levels vary depending on the Plan you have selected to participate in.  Please refer to your Summary Plan Document (SPD) for specific information.

All of the medical plans provide FREE coverage for certain preventive medications required by the Accountable Care Act (ACA or Healthcare Reform).  For more information on which drugs are covered go to www.healthcare.gov or call Navitus Customer Care toll-free at (866) 333-2757.

To find out what copayments are applicable to your specific medications you may log on to www.navitus.com or you can call Navitus Customer Care toll-free at (866) 333-2757.

 

 

 

 

 
 
 

How do I fill a prescription when I travel for business or vacation?

If you are traveling for less than one month, any Navitus Network Pharmacy can arrange in advance for you to take an extra one-month supply. A copayment will apply.

Visit www.navitus.com for complete instructions on filling prescriptions while traveling, or contact Customer Care toll-free at (866) 333-2757.

If you are traveling for more than one month, you can request that your pharmacy transfer your prescription order to another network pharmacy located in the area where you will be traveling.

Can prescriptions be mailed to me if I’m outside of the United States?

Prescriptions cannot legally be mailed from any pharmacy in the United States to locations outside of the country, except for U.S. territories, protectorates and military installations.

What are Specialty Drugs?

Specialty medications are an important part of the treatment for many chronic illnesses and complex diseases such as certain cancers, rheumatoid arthritis, multiple sclerosis, and Hepatitis C.   These medications require personalized coordination between the member, prescriber and pharmacy.  Therefore these medications are generally filled by a Specialty Pharmacy who can deal directly with the patient’s personal needs.

How do I use the Navitus SpecialtyRx program?

Navitus works with Lumicera Health Services to offer services with the highest standard of care. You will get one-on-one service from skilled pharmacists. They will answer questions about side effects and give advice to help you stay on course with your treatment. With Lumicera, delivery of your specialty medications is free, and right to your door or prescriber’s office via FedEx.

Local courier service is available for emergency, same-day medication needs. To start using Lumicera, please call toll-free 1-855-847-3553 and they will work with you and your prescriber for current or new specialty prescriptions.

 

How does the RxCENTS (Tablet Splitting) program work?

The Tablet Splitting program saves you money by breaking a higher-strength tablet in half to provide the needed dose. You will receive the same medication and dosage while purchasing fewer tablets and saving on your copayment.

There are two ways to get started with the Tablet Splitting program:

  1. Call your doctor and ask them whether tablet splitting is an option for you. He or she can update your prescription with your pharmacy if appropriate.
  1. Ask your pharmacist to help change your prescription to one that can be split through the Navitus Tablet Splitting program.

Tablet splitting is not required by Navitus, but is simply offered to you as a way to help control costs. If you have any questions, or would like to receive a tablet splitter, please contact Navitus Customer Care toll-free at (866) 333-2757.

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