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Cochise County Pharmacy Plan

Information on Cochise County pharmacy plans, summary of benefits, vendor links and forms.

Our Mission: Navitus Health Solutions is a full-service pharmacy benefit company committed to lowering drug costs, improving health, and providing superior customer service in a manner that instills trust and confidence.

Stewardship of our clients’ programs is not just what we do—it is our top priority. We take great pride in achieving a perfect score on the 2013 Pharmacy Benefit Management Institute (PBMI) customer satisfaction report, which reflects our people-first commitment.

We Share a Clear View to take transparency and full pass-through to new heights to deliver extraordinary value and put financial control in our clients’ hands. Our focus is on improving member well-being and optimizing value—as evidenced by our year-over-year drug trend rate, which is consistently well below the national trend, and outstanding generic fill rate. An extensive suite of customizable PBM services enables us to tailor solutions to meet each client’s specific needs.

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

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

CCT’s current prescription drug copayment structure is as follows:

Retail Retail Retail Retail
30-Day Supply 30-Day Supply 90 or Mail Order Supply 90 or Mail Order Supply
Non-Network Non-Network
Generic $10 $15 $20 $25
Preferred Brand $30 $35 $60 $65
Non-Preferred Brand $60 $65 $120 $125

The Specialty Rx copayment is $100.

All Proton Pump Inhibitors (i.e., Nexium, Prevacid, etc.) are covered at 50%.

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.

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.

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.

Whom do I call to request additional ID cards?

You can request replacement cards by calling Navitus Customer Care toll-free at (866) 333-2757. You should receive your new card within 7 to 10 calendar days from the date of your request

How do I use the AmeriBen SpecialtyRx program?

Navitus Specialty Rx works with Lumicera Pharmacy to offer services with the highest standard of care. You will get one-on-one service with skilled pharmacists. They will answer questions about side effects and give advice to help you stay on course with your treatment. With Navitus Specialty Rx, 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 Navitus Specialty Rx, please call toll-free 855-847-3553. Navitus will work with your prescriber for current or new specialty prescriptions.

ECANo matter your position – CEO, Superintendent, City Manager, HR Director, Director of Finance, or Administrative Assistant – understanding employee benefits can be overwhelming. Health Care Reform has drastically changed the landscape of employee benefit programs, and continues to do so. Staying abreast of ever-changing legislation, focusing on corporate compliance and continuing to educate employees on their benefits package is no easy task. ECA partners with our clients as an extension of staff to give objective advice, through transparent policies and comprehensive education.

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Additional Information

Formulary Changes

Levothyroxine, Levothroid and Unithroid
Voltaren Gel 1%
Alvesco, Pulmicort, Donnatal/Donnatal Extd, Naprelan, Invokana
Combipatch and Tetracycline
Zolpidem
Hydrocodone
Doxycycline Hyclate, Metronidazole
Proventil HFA
Ortho Evra
Axert, Frova, Relpax

Specialty Pharmacy Products

Specialy Product List

Drug Recalls

Nephron Pharmaceuticals – Albuterol Sulfate Inhalation Solution
Abbott – Glucose Test Strips

If you elect medical coverage, prescription drug coverage through Navitus Health Solutions is automatic.

  • All prescriptions must be filled at a network pharmacy or through the mail-order service. Navitus has a nationwide network of contracted pharmacies including chain store and independent pharmacies.
  • Prescription Drug Out-of-Pocket Limit, per Plan Year
  • Per plan participant – $4,350.
  • Per family unit – Prescription drug charges for a family unit apply to the Medical Benefits out-of-pocket limit (family unit coverage).
CCT Prescription Drug coverage is as follows:

 

Retail Pharmacy (up to a 30-day supply at participating pharmacies

Network Non-Network
         Tier 1 $10.00 co-pay $15.00 co-pay
         Tier 2 $30.00 co-pay $35.00 co-pay
         Tier 3 $60.00 co-pay $65.00 co-pay
         Specialty $100.00 co-pay Not Covered

Retail 90 or Mail Order Pharmacy (up to a 90-day supply at participating pharmacies)

Network  Non-Network
         Tier 1 $20.00 co-pay $25.00 co-pay
         Tier 2 $60.00 co-pay $65.00 co-pay
         Tier 3 $120.00 co-pay $125.00 co-pay

Mandatory Specialty Medications (up to a 30 day supply) – $75.00 co-pay

All Proton Pump Inhibitors (i.e., Nexium, Prevacid, etc.) are covered at 50%

Singulair will be covered on Tier 2 for Patients with Asthma and on Tier 3 for Patients with Allergies

Below are descriptions of the Navitus Select Formulary drug tiers:

Tier 1 – Formulary generics and certain low cost brand name drugs

Tier 2 – Formulary brand name drugs and certain higher costs generic drugs

Tier 3 – Non-formulary drugs, both brand and generic

Speciality Drugs – Are biotech drugs to treat chronic, serious, or rare disease. In most cases, these drugs are delivered by injection or infusion requiring complex care, special storage and handling, strict compliance requirements, or extra patient support. Some health conditions are, but not limited to, Crohn’s disease, growth hormone deficience, multiple sclerosis, rheumatoid arthritis, solid organ transplant, and viral hepatitis. Specialty medications are only available through the Navitus Speciality/RX Program Pharmacy.

Additional prescription programs you should be aware of:

Mail Order Services – This program is part of your pharmacy benefit and is voluntary. The Mail Order Service allows you to receive a 90-day supply of maintenance medications.

90 Day at Retail Program – This program is part of your pharmacy benefit and is voluntary. The 90 day at Retail program allows you the convenience of receiving up to a 90 day supply of most medications at participating retail pharmacies. If you get a prescription filled on a regular, recurring basis, talk to your doctor about writing a prescription for a 90 day supply.
For more detailed coverage information, reference the Summary Plan Document or contact your benefits department.