State of Wisconsin
It's Your Choice 2017
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
Navi-Gate for Members
What is the cost of your drug?
With the change in 2016 from Copayments to Coinsurance for Level 2, 3 and 4 drugs, it is important to be able to determine the total cost of your drugs so that you have an estimate of what your coinsurance will be. Keep in mind that drug pricing can change frequently so the cost of a drug in October may not be the same in January of the following year. You can find what coverage level your drug is at by referring to the formulary on Navitus’ web site. Guidance on finding the formulary on Navitus’ web site are near the end of this document.
Your Pharmacist Knows…
One option to find the total cost of your drug is to contact your pharmacist and ask what the total cost is. If you take this approach, show your pharmacist your Navitus ID card if necessary and be sure to inform your pharmacist that…
- you are a State or Wisconsin Public Employers (WPE) group health insurance program member,
- Navitus Health Solutions is your Pharmacy Benefit Manager, and
- you need to know the Navitus discounted cost of the drug – not the full retail cost
You can then multiply the total cost of the drug by the appropriate coinsurance percentage to arrive at the amount you will pay for your drug. For example, if the Navitus discounted cost of a Level 2 drug is $200, your cost would be $40 ($200 x 20%). The most you will pay for a level 2 drug is $50 based on the maximum Level 2 coinsurance = $50 established by the Group Insurance Board.
NOTE: If you are enrolled in an HDHP you will pay the full discounted price until your deductible has been met.
Your Medication History is on Navitus’ web site: Navi-Gate for Members…
Another option to find the total cost of your drug is to review your medication history for 2015 via the Navi-Gate for Members portal on Navitus’ web site. The “Medication History” page includes the amount the plan has paid and the amount you have paid for prescription drug claims processed by Navitus. The sum of these two amounts is the total cost of your drug:
- At the “MEMBERS” portal click on the “Member Login >” link near the bottom-center of the page.
- At the Member Login page enter your User ID and Password, then click the “Logon” button:
- Your User ID is the 8-digit Member ID found on your Navitus ID Card.
- If you haven’t already registered on the Navitus web site, click on the “Click here for new registrations” link. Then follow the instructions on the screen to get registered. Be sure to have your Navitus ID card handy as you will need your 8-digit Member ID to register.
- A second Logon Page will ask you to answer one of your personal security questions.
- Once logged on, click on the “Medication History” option on the left side of the screen.
- The Medication History page shows the prescriptions you have had filled as far back as 18 months.
- Select “From” and “Thru” dates and click the “Search” button.
We recommend selecting the most recent three- to six-month time period in 2015 to determine the most up-to-date cost of the drugs you currently take.
- All prescriptions filled within the date range selected will be displayed, as shown below.
The total cost of the drug is the sum of the “Patient Pays” and “Plan Pays” amounts.
Please note that the samples shown above are actually Level 1 drugs and the actual cost is less than the copayments.
Finding the Formulary...
The formulary will show you what coverage level your drug is classified as so that you can determine what coinsurance or copayment will apply.
- While still logged on to the Navi-Gate for Members page, click on the “Formulary” option on the left side of the screen. Once at the Formulary page, click on the “Complete Formulary” link located at the top of the list near the bottom of the page.
- This link will open the formulary in a PDF document where you will be able to identify the coverage level for your drug. Search functions are available in the PDF document.
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.
This page was last modified on: 8/19/2016 12:07:12 PM