Medicine

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PRESCRIPTION DRUG BENEFIT

The prescription drug program is part of the medical plan and is administered by Navitus Health Solutions. Prescription drugs are subject to the medical deductible and then to three tiers of coinsurance up to the medical out-of-pocket maximum. Once you reach the medical out-of-pocket maximum, the plan will pay 100% of your eligible medical and prescription costs for the remainder of the calendar year.

The prescription drug program provides you with savings when you purchase prescriptions from participating pharmacies. The Navitus Network includes many independent stores, as well as widely known chains.

The prescription card is the same as your health insurance card. When the pharmacist enters your prescription, the Navitus system will tell the pharmacist if your deductible has been met. Once your deductible has been met, their system will calculate the appropriate coinsurance you need to pay, and your pharmacist will charge you for that amount. Navitus will reimburse the pharmacy for the balance.

 

GETTING YOUR PRESCRIPTIONS THROUGH MAIL ORDER

If you are taking a medication over an extended period, you can have it mailed directly to your home through the mail-order program. This feature makes buying medication for an ongoing condition (such as diabetes, high blood pressure or heart condition) more convenient. Not only does the drug come directly to your home, but you may be able to order up to a 90-day supply at a time at a reduced cost. To get started, complete the mail-order enrollment process online at www.ppsrx.com. You may also contact PPS Customer Care by phone. They can be reached toll-free at 1-800-552-6694.

The drug plan offers Postal Prescription Services (PPS), a subsidiary of The Kroger Company (a parent of Pick ‘N Save and Metro Market), as its mail-order pharmacy. Prescriptions can be mailed to your home, or you can pick up your prescription at a Kroger pharmacy at the same low mail-order

 

SPECIALTY Rx

Navitus SpecialtyRx works with our specialty partner, Lumicera Health Services, 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 SpecialtyRx, there is no delivery charge, and the medication is sent right to your door or prescriber’s office. Local courier service is available for emergency, same day medication needs. To start using Navitus SpecialtyRx, please call toll-free 1-855-847-3553. Lumicera will work with your prescriber for current or new specialty prescriptions.

TRIA HEALTH

Tria Health Program

(for members who are identified with chronic medical conditions) 

 

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The detail of the prescription benefit is contained in the official Plan document. This site is meant to only cover highlights of the prescription benefit. It does not contain all of the details that are included in the Summary Plan Description (SPD) (as described by the Employee Retirement Income Security Act). If there is ever a question about this plan, or if there is a conflict between the information on this site and the formal language of the Plan documents, the formal wording in the Plan documents will govern. Please note that the benefits described on this site may be changed at any time and do not represent a contractual obligation on the part of Marquette University.

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