About
Navitus Health Solutions redefines pharmacy benefit management with a people-first, fully transparent approach. Unlike traditional PBMs that retain rebates and markups, Navitus operates on a cost-plus, pass-through model where every dollar saved from manufacturer rebates and network discounts flows directly back to plan sponsors and their members—no hidden fees, no spread pricing. Navitus serves a broad range of clients including employer groups, health plans, government programs, and other healthcare organizations. Its comprehensive suite of solutions includes claims adjudication, formulary and utilization management, pharmacy network management, cost-plus specialty pharmacy, medical specialty drug management, and robust member enablement and support services. Members benefit from affordable prescription access backed by an industry-leading satisfaction rate, while plan sponsors gain customizable benefit designs tailored to their workforce's unique needs. Navitus also provides actionable market intelligence through resources like its annual Drug Trend Report and PBM 101 educational content. The platform is particularly well-suited for mid-to-large employers, health plans, and government programs seeking a credible alternative to legacy PBMs. With a proven track record of exceeding projected savings and a commitment to transparent partnerships, Navitus stands out as a trusted, mission-driven solution in the pharmacy benefits space.
Key Features
- Pass-Through Pricing Model: All manufacturer rebates and discounts are passed directly to clients with no hidden fees or spread pricing, maximizing savings transparency.
- Claims Adjudication: End-to-end pharmacy claims processing that ensures accurate, timely adjudication for plan sponsors and members.
- Formulary & Utilization Management: Customizable formulary design and utilization management programs that balance clinical outcomes with cost-effectiveness.
- Cost-Plus Specialty Pharmacy: Specialty drug management at cost-plus pricing, eliminating markups on high-cost specialty medications.
- Member Enablement & Support: Comprehensive member support services including drug cost tools, pharmacy locators, and dedicated customer service.
Use Cases
- A large employer redesigns its prescription drug benefit using Navitus's customizable formulary management to reduce employee out-of-pocket costs while cutting plan spend by 15-20%.
- A regional health plan partners with Navitus to replace its legacy PBM and eliminate spread pricing, passing rebate savings directly to plan members to lower premium costs.
- A government healthcare program leverages Navitus's claims adjudication and pharmacy network management to ensure cost-effective, compliant prescription drug coverage for beneficiaries.
- A mid-size corporation uses Navitus's specialty pharmacy management to control rising costs on biologics and other high-cost specialty drugs for employees with chronic conditions.
- An HR team uses Navitus's member support services and drug cost transparency tools to help employees find the most affordable pharmacy options within their benefit plan.
Pros
- Full Transparency: Navitus passes 100% of rebates and discounts to clients, eliminating conflicts of interest inherent in traditional PBM models.
- Proven Cost Savings: Clients consistently report prescription drug cost reductions of up to 20% compared to traditional PBMs, often exceeding projected savings.
- Customizable Solutions: Highly flexible benefit designs allow plan sponsors to tailor programs to their specific workforce and member needs.
- High Member Satisfaction: Navitus maintains strong member satisfaction rates, reflecting accessible, affordable, and patient-centered service delivery.
Cons
- Enterprise-Focused: Navitus primarily targets mid-to-large employers and health plans; small businesses may find limited tailored options.
- Not a Consumer-Direct Platform: Individual consumers cannot sign up directly—access is only available through employer groups, health plans, or government programs.
- Limited Self-Service Tooling: The member-facing portal and digital tools may be less feature-rich compared to larger, technology-first PBM competitors.
Frequently Asked Questions
What makes Navitus different from traditional PBMs?
Navitus operates on a fully transparent, pass-through model. Unlike traditional PBMs that retain manufacturer rebates and apply spread pricing, Navitus passes all savings directly to clients, eliminating hidden fees and conflicts of interest.
Who can use Navitus pharmacy benefits?
Navitus serves employer groups, health plans, government programs, and other plan sponsors. Individual members access benefits through their employer or health plan that has contracted with Navitus.
How much can organizations save with Navitus?
Navitus clients typically reduce prescription drug costs by up to 20% compared to traditional PBMs, with many clients reporting savings that exceed initial projections.
Does Navitus handle specialty pharmacy?
Yes, Navitus offers cost-plus specialty pharmacy and medical specialty drug management, providing transparent pricing on high-cost specialty medications without traditional markups.
What resources does Navitus provide to help plan sponsors stay informed?
Navitus publishes an annual Drug Trend Report, PBM 101 educational content, latest industry insights, and hosts upcoming events to keep plan sponsors and consultants well-informed on pharmacy benefit trends.
